Austin Frakt suggests that the ACA mandate is tougher than the Massachusetts mandate once it is fully phased-in in this useful and interesting post. He also writes, to his credit, the following:
Since there is little evidence of substantial gaming in Massachusetts, based on an analysis of penalty size alone there would seem to be little cause for concern over gaming under ACA, particularly for higher income individuals. This analysis ignores other differences between Massachusetts and its health reform law and the national population and ACA, respectively. Results are sensitive to assumptions, but I deliberately selected those conservatively as indicated above.
Reader Jim Fair kindly pointed me to an important provision in the Massachusetts law that is not present in ACA, as I understand it. The following is from a summary provided by Healthinsuranceinfo.net:
- If you buy individual health insurance through Commonwealth Choice you may face a pre-existing exclusion period. No pre-existing condition exclusion period can be applied unless you have a break of 63 or more days of continuous coverage. Pre-existing condition exclusion periods can last up to 6 months. Commonwealth Choice plans can look back 6 months to see if you actually received care or treatment for a condition. In addition, pregnancy can be considered a pre-existing condition in individual health insurance. Genetic information cannot be considered a pre-existing condition.
- No preexisting condition exclusion period can be imposed if you are HIPAA eligible.
This strikes me as a powerful disincentive to going without coverage that effectively strengthens the mandate.
Frakt titles his post, “Individual Mandate Penalties Are Adequate.” I’m struck by his confidence, and impressed by it.