States Preparing to Create Their Own Obamacare Mandates


Republicans have eliminated the unpopular Obamacare individual mandate penalty for not having health insurance, but some states are preparing to have their own individual mandate.

And they’re likely to add outreach activities and other ways to get uninsured people signed up as they do so.

New Jersey is the first state poised to enact its own individual mandate after the repeal of the penalty under the Tax Cuts and Jobs Act of 2017 signed by President Donald Trump. The individual mandate bill, paired with a measure to set up a state reinsurance program to cover high-cost medical claims, won approval from the Democratic-controlled Assembly and state Senate April 12 along party lines. The bill is now headed to newly elected Gov. Phil Murphy (D).

The District of Columbia also may pass legislation this year that would require residents to buy qualified health insurance under the Affordable Care Act or pay a fine.

Unlike the federal Affordable Care Act individual mandate, however, the District of Columbia would automatically exempt people from the penalty if they make below set income levels, Mila Kofman, executive director of the DC Health Benefit Exchange Authority, told me.

Currently, people have to apply for exemptions from paying the penalty, which will be eliminated in 2019.

In addition, the District of Columbia’s bill includes provisions to notify people who are subject to the fine that coverage is available, Kofman said. “It would help us because the tax and revenue office here would be doing outreach directly to people who were uninsured,” she said. “The whole idea behind the fine is not to collect it but to get them covered.”

Other states that are considering legislation that would do something to push people to get enrolled in the absence of a mandate penalty include Vermont, Hawaii, and Connecticut, Rachel Schwab, a research associate with Georgetown University’s Center on Health Insurance Reforms, told me.

In Vermont, the state Legislature is considering legislation that would allow a working group to consider ways to get people enrolled, including an automatic enrollment system to get people signed up, Adaline Strumolo, health-care director for the Department of Vermont Health Access, told me.

But one state moving in the opposite direction is Ohio. The Buckeye State has requested permission from the U.S. Department of Health and Human Services to eliminate the individual mandate altogether.

Removing the mandate wouldn’t have any impact on the state’s individual health insurance market because Congress has already eliminated the penalty as of 2019, the state Department of Insurance said.

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