Vicki Fung (
Catherine Y. Liang was a research assistant at the Mongan Institute Health Policy Center, Massachusetts General Hospital, at the time this work was completed. She is a master of public health student at the University of Toronto, in Ontario, Canada.
Health Aff (Millwood). 2019 Jan;38(1):147-154. doi: 10.1377/hlthaff.2018.05161.
The tax penalty for noncompliance with the Affordable Care Act's individual mandate is to be eliminated starting in 2019. We investigated the potential impact of this change on enrollees' decisions to purchase insurance and on individual-market premiums. In a survey of enrollees in the individual market in California in 2017, 19 percent reported that they would not have purchased insurance had there been no penalty. We estimated that premiums would increase by 4-7 percent if these enrollees were not in the risk pool. The percentages of enrollees who would forgo insurance were higher among those with lower income and education, Hispanics, and those who had been uninsured in the prior year, relative to the comparison groups. Compared to older enrollees and those with two or more chronic conditions, respectively, younger enrollees and those with no chronic conditions were also more likely to say that they would not have purchased insurance. Eliminating the mandate penalty alone is unlikely to destabilize the California individual market but could erode coverage gains, especially among groups whose members have historically been less likely to be insured.
自 2019 年起，将取消对不符合《平价医疗法案》个人授权规定的税收处罚。我们调查了这一变化对参保人购买保险的决定以及对个人市场保费的潜在影响。在对 2017 年加利福尼亚州个人市场参保人的一项调查中，19%的人表示如果没有处罚，他们就不会购买保险。我们估计，如果这些参保人不在风险池中，保费将增加 4-7%。与对照组相比，收入和教育程度较低、西班牙裔以及在前一年没有保险的参保人放弃保险的比例更高。与年龄较大的参保人和有两种或两种以上慢性病的参保人相比，年轻的参保人和没有慢性病的参保人也更有可能表示他们不会购买保险。仅取消授权处罚不太可能使加利福尼亚州的个人市场失去稳定，但可能会侵蚀覆盖范围的扩大，尤其是在那些历史上参保人数较少的群体中。
