The Affordable Care Act (ACA) had an individual mandate that required consumers nationwide to have health insurance coverage or pay a penalty. Show
Advocates argued that the mandate helped to control health insurance costs. Opponents said consumers should be able to decide whether they wanted to buy health insurance without consequence. Congress voted to remove the ACA penalty in 2017. Since then, some states now have their own health insurance mandates, but not all of them have a financial penalty.  The Patient Protection and Affordable Care Act, also known as the ACA or Obamacare, is the sweeping health-reform law enacted in 2010. One of the most controversial aspects of the Affordable Care Act was the individual mandate. The mandate aimed to encourage Americans to maintain health insurance coverage. This meant that most people who did not sign up for health insurance faced a financial penalty. The mandate drew widespread criticism from those who believed having a health insurance plan should be a personal choice. History of the Obamacare individual mandateOfficially titled as the “Individual Shared Responsibility Provision,” the ACA individual mandate required most Americans to have health insurance coverage. Those who did not comply faced paying a shared responsibility payment — which is a penalty or fine — with your state or federal tax return. Mandate supporters argued that a penalty increased the number of Americans with health insurance. They also said the mandate helped to control costs, because the pool of younger and healthier customers helped offset the healthcare system’s expenses for those who were older and sicker. Mandate opponents argued that no one should be forced to buy health insurance. What were the requirements for the Obamacare individual mandate?The individual mandate required consumers and their dependents to have health insurance. There were certain health plans that qualified as "minimum essential coverage," including: How much was the financial penalty for not having individual health insurance?When the ACA was first enacted in 2010, the Obama administration wanted to give consumers the opportunity to adjust to the mandate. As a result, the penalty began in 2014 and increased over time. The penalty was calculated as the greater of the following:
The penalty also could not be higher than the national average premium for bronze plans offered through the ACA marketplace at the time. Was the ACA individual penalty removed?In a word: Yes. From the moment the ACA went into effect, the American public had a divided opinion about the individual mandate and penalty. For example, a 2017 report by the Urban Institute’s Health Policy Center found that 39.3% of adults age 18 to 64 surveyed wanted to repeal the individual mandate. This is compared to 29.6% who wanted to keep it and 30.5% who were undecided. The mandate was particularly unpopular among Republicans. In 2017, a Republican-led Congress eliminated the penalty for Americans without health insurance in passing the Tax Cuts and Jobs Act. The change was effective in 2019. Is the ACA individual mandate still in effect in some states?No, but some states apply their own health insurance mandates. Though the ACA individual mandate is no longer a national requirement, some states have mandates that may or may not have a financial penalty. Residents of California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia are required to buy health insurance and face a penalty without coverage or an exemption. States including Maryland and Vermont require residents to report their insurance status but do not have a financial penalty for being uninsured. How much is the penalty in states with a healthcare mandate?Each state or district with a healthcare mandate has its own process for calculating the penalty. In California, residents must have qualifying health coverage or an exemption. If not, the penalty for the 2021 tax year is the greater of:
In Massachusetts, the individual mandate applies only to adults age 18 and older. The mandate doesn’t apply to those who have a qualified hardship or an exemption and those who make less than 150% of the federal poverty level (FPL). The penalty is assessed on a sliding scale. For the 2021 tax year, individuals without insurance must pay:
In New Jersey, the penalty is assessed based on the months of the year that people in your household did not have minimum essential coverage or a coverage exemption. For the 2021 tax year, the amount ranges between $695 and $3,492 for an individual taxpayer and is more for households based on size. In Rhode Island, the penalty for the 2021 tax year is the higher of:
In the District of Columbia, the penalty for the 2021 tax year is the greater of:
In Vermont, there is no financial penalty if you are uninsured. However, residents must say whether they have health insurance when they file their state taxes. Maryland is among the states that ask residents about health insurance status on state tax filings as an avenue to enrollment. Why do some states still mandate healthcare coverage?According to a report by USC-Brookings Schaeffer Initiative for Health Policy, some states still mandate health insurance coverage in an attempt to reduce costs for everybody. Proponents argue that having healthy people buy health insurance protects them if they need care while offsetting insurer costs for sicker patients who access services more frequently. States also mandate coverage to ensure insurance policies meet designated standards and to increase revenue. Individual mandate reporting as entry to insurance coverageWhile most states don't mandate coverage, some are using creative ways to entice residents to buy health insurance. Maryland asks residents about health insurance coverage on state tax forms. The state notifies residents if they are eligible for Medicaid or subsidized insurance under the state insurance marketplace. How does the Obamacare individual mandate differ from the employer mandate?The Obamacare individual mandate required individuals to have health insurance. The employer mandate is a part of the ACA that requires businesses of a certain size to offer health insurance to their employees. Employers with 50 or more full-time employees must offer minimum essential coverage to 95% of their employees or pay a penalty. The bottom lineThe ACA individual mandate nudged consumers to have health insurance by imposing a financial penalty if they did not have coverage or an exemption. Congress removed the national mandate in 2017. Some states have their own health insurance mandates that impose financial penalties. Other states ask about insurance status on state tax filings with no penalty. This information is used to usher uninsured residents who qualify into options such as ACA marketplace coverage with subsidies and Medicaid. GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines. Was this page helpful?thumb_up_outlinedthumb_down_outlined Subscribe and save.Get prescription saving tips and more from GoodRx Health. Enter your email to sign up.By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx. What are the provisions of the Patient Protection and Affordable Care Act quizlet?Extends health care coverage to 30 million uninsured Americans, provides substantial subsidies to uninsured individuals and small business firms to make health insurance more affordable, contains provisions to lower health care costs in the long run, and prohibits insurers from engaging gin certain abusive practices.
What was one of the goals of the Affordable Care Act ACA quizlet?The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government.
What is the individual mandate quizlet?What is the Individual Mandate? A requirement that all individuals and employers purchase health insurance. There is a penalty tax for failure to comply.
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