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    • The Individual Health Care Mandate of the Affordable Care Act: To Be or Not To Be?


      Posted by
      Published On Nov 01 2013, 3:39 AM

      ACA_forblogDebates are gripping Capitol Hill regarding the individual mandate of the Affordable Care Act (ACA). The mandate requires individuals to sign up for private insurance or Medicaid by March 31, 2014 or face a penalty of $95 per adult and $47.50 per child up to a maximum of $285 per family or 1.0% of family income, whichever is greater.

      Should the individual mandate be delayed?

      That is the question law makers are currently asking. A delay would destabilize the new health exchanges (or marketplace) eliminating the requirement that everyone enroll must in a plan. Under the ACA, everyone must be allowed to buy insurance regardless of any pre-existing conditions. As a result, insurance companies must accept anyone who applies, regardless of age or health. The trade-off is that everyone is required to buy into the system so that insurance companies can have enough healthy customers to keep premiums low for everyone.

      The penalty against individuals lacking health care coverage is a crucial tool in the effort to drive people into the new system. Delay it, and you'll get fewer people signing up in the first part of next year, and insurance companies will demand, with good reason, to renege on the rates they are offering for next year's coverage.

      Given the slow pace of enrollment into exchanges, the Administration and everyone tracking this issue is wondering whether a sufficient number of "healthy" individuals will enroll to carry the burden of the sicker enrollees. Only time will tell.

      Covance is monitoring this issue, especially as it relates to patient assistance programs. Will your current PAP patients enroll in health exchanges or Medicaid? Who will be allowed free product in 2014? Covance can work with you to conduct data analyses to determine your exposure in 2014 and beyond. Here's where to start.

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    About Marissa Fuller, MHS

    Marissa Fuller, Director, has been in the field of reimbursement and market access for 17 years. She is leading the health care reform practice for Covance Market Access Services and has expertise in launch-related services. Ms. Fuller has developed a series of on-line apps for clients. She has an MHS from the Johns Hopkins Bloomberg School of Public Health and a BA from Barnard College, Columbia University.