The importance of the individual mandate to the Affordable Care Act’s exchanges has been greatly exaggerated. It has done little to increase enrollment, to reduce insurance premiums, or to alleviate the burden of uncompensated care. Rather, the main effect of the provision has been to concentrate more of the expense of covering the chronically ill on the relatively small cohort of working Americans who lack employer-sponsored coverage. By doing so, the mandate has served to obscure the total cost of the entitlement.
This issue brief examines the intent of the individual mandate, investigates why it was implemented in its present form, and demonstrates that its poorly distributed penalties have done little to enhance the affordability of health insurance or the stability of the individual market.