Price Carter C, Saltzman Evan
Rand Health Q. 2013 Sep 1;3(3):6. eCollection 2013 Fall.
In July 2013, the Obama administration announced a one-year delay in enforcement of the Affordable Care Act's (ACA) penalty on large employers that do not offer affordable health insurance coverage. To help policymakers understand the implications of this decision, RAND analysts employed the COMPARE microsimulation model to gauge the impact of the one-year delay of the so-called employer mandate. They found that the delay will not have a large impact on insurance coverage: Because relatively few firms and employees are affected, only 300,000 fewer people, or 0.2% of the population, will have access to insurance from their employer, and nearly all of these will get insurance from another source. However, a one-year delay in implementation of the mandate will result in $11 billion dollars less in federal inflows from employer penalties for that year. A full repeal of the employer mandate would cause revenue to fall by $149 billion over the next ten years (10% of the ACA's spending offsets), providing substantially less money to pay for other components of the law. The bottom line: The one-year delay in the employer mandate will have relatively few consequences, primarily resulting in a relatively small one-year drop in revenue; however, a complete elimination of the mandate would have a large cumulative net cost, potentially removing a nontrivial revenue source that in turn funds the coverage provisions in the ACA.
2013年7月，奥巴马政府宣布将《平价医疗法案》（ACA）对不提供可负担医疗保险的大型雇主的处罚执行推迟一年。为帮助政策制定者理解这一决定的影响，兰德公司的分析师使用COMPARE微观模拟模型来评估所谓雇主强制参保规定推迟一年的影响。他们发现，这一推迟对保险覆盖范围影响不大：由于受影响的公司和员工相对较少，只有30万人（占人口的0.2%）无法从雇主处获得保险，而且几乎所有这些人都能从其他渠道获得保险。然而，强制参保规定实施推迟一年将导致当年联邦政府从雇主处罚中获得的收入减少110亿美元。完全废除雇主强制参保规定将导致未来十年收入减少1490亿美元（占ACA支出抵消额的10%），从而大幅减少用于支付该法律其他部分的资金。底线是：雇主强制参保规定推迟一年的后果相对较少，主要导致收入相对小幅下降；然而，完全取消该规定将产生巨大的累计净成本，可能会消除一个重要的收入来源，而这个来源反过来又为ACA中的保险条款提供资金。
