State-Run Insurance Exchanges in Federal Healthcare Reform: A Case Study in Dysfunctional Federalism

2012 ◽  
Vol 38 (2-3) ◽  
pp. 548-569
Author(s):  
Kyle Thomson
Keyword(s):  
Health Insurance ◽  
Small Business ◽  
Affordable Care Act ◽  
Bargaining Power ◽  
Healthcare Reform ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual ◽  
Insurance Exchanges

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law, resulting in the most sweeping reform of the healthcare marketplace and one of the largest expansions in access to healthcare in American history. A key component to both restructuring the healthcare marketplace and improving access are the health insurance exchanges contained in the ACA. Today, individual and small group purchasers have difficulty finding affordable health insurance in the marketplace because they lack the tools to gather information about plans and because they lack the bargaining power to negotiate for affordable rates the way large purchasers can. In conjunction with the individual mandate, the health insurance exchanges aim to solve inefficiencies in the current marketplace by creating a centralized venue to connect insurers with individual and small business purchasers. Thus it both creates a place for insurers to readily find customers, who are now guaranteed to be there because of the individual mandate, and provides a place for customers to shop for insurance.

The Individual Mandate: Implications for Public Health Law

2011 ◽  
Vol 39 (3) ◽  
pp. 401-413 ◽  
Author(s):  
Wendy E. Parmet
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Universal Coverage ◽  
Health Law ◽  
Healthy Individuals ◽  
Sick People ◽  
Patient Protection ◽  
Death Spiral ◽  
Individual Mandate ◽  
The Individual

No provision of the Patient Protection and Affordable Care Act (PPACA) has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The price of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans.

scholarly journals Narrow Networks on the Health Insurance Exchanges: What Do They Look Like and How Do They Affect Pricing? A Case Study of Texas

2015 ◽  
Vol 105 (5) ◽  
pp. 110-114 ◽  
Author(s):  
Leemore Dafny ◽  
Igal Hendel ◽  
Nathan Wilson
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
First Year ◽  
Narrow Gap ◽  
Limited Evidence ◽  
Hospital Networks ◽  
Using Data ◽  
Narrow Networks ◽  
Insurance Exchanges

The Affordable Care Act has engendered significant changes in the design of health insurance products. We examine the “narrowness” of hospital networks affiliated with plans offered in the first year of the marketplaces. Using data from Texas, we find limited evidence of a tight link between pricing and a simple measure of network breadth, or a more complex measure of network value derived from a logit model of hospital choice. The state's largest insurer priced its narrow networks at a fairly constant discount relative to its broad networks, notwithstanding significant variation in its broad-narrow gap across geographic markets in Texas.

Religious Exemptions to the PPACA's Health Insurance Mandate

2011 ◽  
Vol 37 (4) ◽  
pp. 624-651 ◽  
Author(s):  
Samuel T. Grover
Keyword(s):  
Health Insurance ◽  
Focal Point ◽  
Circuit Court ◽  
Patient Protection ◽  
Commerce Clause ◽  
Legal Challenges ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Circuit Courts

Arguably the most controversial change to the U.S. healthcare system written into the Patient Protection and Affordable Care Act (“PPACA” or the “Act”) is what has been colorfully termed the Act’s “individual mandate,” the provision that establishes tax penalties for those who do not maintain health insurance in 2014 and beyond. Though the health insurance mandate does not go into effect until 2014, it has already faced numerous constitutional challenges in district and circuit courts, with entirely inconsistent results. Conflicting decisions regarding the Act’s constitutionality at the circuit court level cry out for Supreme Court review. But while the individual mandate’s validity under either the Commerce Clause or Congress’s taxing power has been the focal point of litigation thus far, another aspect of the individual mandate may undermine the goal of establishing universal, affordable healthcare coverage for all Americans. As currently written, the religious conscience exemption from the PPACA’s individual mandate threatens the efficacy of the Act and potentially exposes it to legal challenges under the Constitution’s Religion Clauses.

Congress, Courts, and Commerce: Upholding the Individual Mandate to Protect the Public's Health

2011 ◽  
Vol 39 (3) ◽  
pp. 394-400 ◽  
Author(s):  
James G. Hodge ◽  
Erin C. Fuse Brown ◽  
Daniel G. Orenstein ◽  
Sarah O'Keefe
Keyword(s):  
Health Insurance ◽  
United States Supreme Court ◽  
Federal District ◽  
District Courts ◽  
Patient Protection ◽  
Legal Challenges ◽  
Individual Mandate ◽  
Attorneys General ◽  
The Individual ◽  
Federal District Courts

Despite historic efforts to enact the Patient Protection and Affordable Care Act (PPACA) in 2010, national health reform is threatened by multiple legal challenges grounded in constitutional law. Premier among these claims is the premise that PPACA’s “individual mandate” (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is constitutionally infirm. Attorneys General in Virginia and Florida (joined by 25 other states) allege that Congress’ interstate commerce powers do not authorize federal imposition of the individual mandate because Congress lacks the power to regulate commercial “inactivity.” Stated simply, Congress cannot regulate individuals who choose not to obtain health insurance because they are not engaged in a commercial venture. Several courts initially considering this argument have rejected it, but two federal district courts in Virginia and Florida have concurred, leading to numerous appeals and the near promise of United States Supreme Court review.

scholarly journals Health Reform and the Constitutionality of the Individual Mandate

2011 ◽  
Vol 12 (4) ◽  
pp. 236-244 ◽  
Author(s):  
Jeffrey J. Lee ◽  
Deena Kelly ◽  
Matthew D. McHugh
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Critical Issue ◽  
Economic Effects ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual

The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty—the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the “activities” Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating “inactivity,” that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform.

Does the Individual Mandate Affect Insurance Coverage? Evidence from Tax Returns

2021 ◽  
Vol 13 (2) ◽  
pp. 378-407
Author(s):  
Ithai Z. Lurie ◽  
Daniel W. Sacks ◽  
Bradley Heim
Keyword(s):  
Health Insurance ◽  
Regression Discontinuity ◽  
Insurance Coverage ◽  
Extensive Margin ◽  
Tax Returns ◽  
Individual Mandate ◽  
The Individual ◽  
Substantial Heterogeneity ◽  
Insurance Exchanges ◽  
Return Data

We estimate the effect of the ACA’s individual mandate on insurance coverage using regression discontinuity and regression kink designs with tax return data. We have four key results. First, the actual penalty paid per uninsured month is less than half the statutory amount. Second, nonetheless, we find visually clear and statistically signifi-cant responses to both extensive margin exposure to the mandate and to marginal increases in the mandate penalty. Third, we find substantial heterogeneity in who responds; men are especially responsive. Fourth, our estimates imply fairly small quantitative responses to the individual mandate, especially in the Health Insurance Exchanges. (JEL G22, H24, H51, I13, I18)

scholarly journals The Taxing Power Of The Federal Government And The General Welfare: What Are The Limits In The Wake Of NFIB V. Sebelius?

2015 ◽  
Vol 76 (3) ◽  
Author(s):  
Mark Klock
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Funds ◽  
Chief Justice ◽  
Commerce Clause ◽  
General Welfare ◽  
Individual Mandate ◽  
Constitutional Constraints ◽  
The Individual

The Affordable Care Act seeks to remedy the problem of information asymmetry in the health insurance market by mandating that everyone obtain health insurance or pay a penalty, and by requiring the States to expand Medicaid or lose existing federal funds. In NFIB v. Sebelius, Chief Justice Roberts held that Congress’ power to regulate under the Commerce Clause could not justify the Individual Mandate to purchase insurance, but that the penalty could be construed as a tax and upheld under the taxing power. Chief Justice Roberts also held the Medicaid Expansion to be an unconstitutional use of spending power, but determined that the Medicaid Expansion could remain with the States having the option to keep existing funding and not expand or expand and take the incremental funding. Eight Justices disagreed with the Chief Justice on the Individual Mandate, and six Justices disagreed with the Chief Justice on the Medicaid Expansion. This creates a paradox in that a supermajority of the Court believes the case was wrongly decided on both main questions. More distressing is the scant analysis given in all of the opinions to the constitutional constraints on taxes.

scholarly journals Constitutional Ratemaking and the Affordable Care Act: A New Source of Vulnerability

2012 ◽  
Vol 38 (2-3) ◽  
pp. 243-268
Author(s):  
Richard A. Epstein ◽  
Paula M. Stannard
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
Patient Protection ◽  
Commerce Clause ◽  
Different Types ◽  
Individual Mandate ◽  
The Government ◽  
The Individual

As this Article is being written, the Patient Protection and Affordable Care Act (ACA) is being besieged with two different types of challenges. The first is a Commerce Clause challenge to the individual mandate on the ground that, although the Commerce Clause allows the government to “regulate” the transactions into which people choose to enter, it does not allow the state to force people to enter into disadvantageous transactions against their own will. The second of these challenges deals with the imposition of the Medicaid expansion provisions requiring a state to forego all of its additional Medicaid support unless it is prepared to extend Medicaid coverage, partially at its own expense, to individuals whose income levels put them at 100% to 133% of the federal poverty level.

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