The minimum coverage provision, or individual mandate, is a provision under the 2010 Affordable Care Act (ACA). According to a short paper recently issued by The Robert Wood Johnson Foundation and the Urban Institute, if the ACA were in effect today, 94 percent of the total population (93% of the nonelderly population) or 250.3 million people out of 268.8 million—would not face a requirement to newly purchase insurance or pay a fine. In this brief, the authors use the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to estimate the number and share of Americans potentially subject to the mandate, identify their insurance status absent the ACA, and simulate eligibility for Medicaid and exchange-based premium and cost-sharing subsidies. To allow the most direct comparison of postreform coverage with coverage absent reform, their analysis treats the provisions of the ACA as if fully implemented in 2011. The results of their analysis are presented in a table format—with estimates of the population exempt from the mandate; the population potentially affected by the mandate but already covered by insurance of some type; and the remaining population required to newly purchase coverage or pay a fine.

The RAND Corporation recently released a report addressing the question "How would removing the individual mandate from the Affordable Care Act (ACA) affect the number of insured individuals, premium costs for those who are insured through the exchanges, and government spending on health coverage?" RAND addressed the question by using COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model to predict the effects of a possible Supreme Court decision invalidating the individual mandate provision in the Affordable Care Act (ACA) while keeping the other parts of the law intact. The authors predict the effects of such a decision on health insurance coverage overall and for subgroups based on income. They also estimate where people will obtain insurance in scenarios with and without the mandate and how the elimination of the individual mandate will affect insurance premiums. The analysis predicted that...

Today the Robert Wood Johnson Foundation (RWJF) released a report authored by researchers from the Urban Institute called "Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care: Timely Analysis of Immediate Health Policy Issues." The report examines the effect that eliminating the individual mandate—the requirement for most Americans to have health insurance or face a penalty—would have on health insurance coverage, spending, premiums and uncompensated care. Using the Urban Institute’s Health Insurance Policy Simulation Model, the researchers simulated the Affordable Care Act as enacted, as well as several alternative scenarios of health reform without the mandate. The authors find that without the mandate: 1) Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate; 2) Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform; 3) Uncompensated care spending would be much higher due to the increased number of uninsured; and 4) Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation, and by 25 percent with a low participation scenario.