How did the ACA’s individual mandate affect insurance coverage? Evidence from coverage decisions by higher income people

Patient Sharon Dawson Coates (L) waits as Dr. Nikhil Narang enters data into her chart after examining her knee
Editor's note:

This analysis is part of the USC-Brookings Schaeffer Initiative for Health Policy, which is a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

The tax legislation enacted in December 2017 repealed the tax penalty associated with the individual mandate—the Affordable Care Act (ACA) requirement that people who do not qualify for an exemption obtain health insurance coverage—effectively repealing the mandate itself. Understanding how the mandate has affected insurance coverage is important for predicting how insurance coverage and insurance markets, particularly the individual health insurance market, are likely to evolve in the coming years.

But how the mandate has affected insurance coverage remains controversial. Most formal analyses, including those produced by the Congressional Budget Office (CBO), conclude that the individual mandate substantially increased insurance coverage and, correspondingly, that repealing the mandate will substantially reduce coverage. But some, including the Trump Administration and Congressional Republicans, have argued that the mandate has had little or no effect on insurance coverage. In “How Did the ACA’s Individual Mandate Affect Insurance Coverage? Evidence from Coverage Decisions by Higher-Income People,” Brookings’ Matthew Fiedler presents evidence that the ACA’s individual mandate did indeed cause substantial increases in insurance coverage.

A blog post summarizing the paper’s findings is available here.

The full paper is available here.