Health insurance mandates require individuals, companies, and providers to provide or participate in health coverage. The US individual mandate requires citizens to obtain health insurance, while the PPACA requires companies with over 50 employees to provide coverage. Mandates extend benefits to previously uncovered conditions and prevent discrimination, but opponents argue they increase costs and force people to pay for services they don’t need.
A health insurance mandate is a mandatory requirement that obliges health care consumers, insurance companies, health care providers, and employers to provide or participate in health coverage. The individual health care mandate in the United States requires every citizen to buy or obtain health insurance to cover their health care costs. The Patient Protection and Affordable Care Act (PPACA) enacted by the US Congress in 2010 also requires companies with more than 50 employees to provide adequate health care coverage for their employees. In addition, state and federal mandates direct and extend benefits in individual policies to include a range of provider types, covered services and patient categories, some of which were not covered prior to PPACA approval. Patient advocates, consumer groups and vendors praise health insurance mandates as a way to ensure comprehensive, non-discriminatory care for all citizens, while opponents criticize the additional costs that health care mandates can impose.
While the health insurance mandate has increasingly become a fixed element in state and federal health insurance regulations, it is also a contentious issue. Proponents of the mandates argue for increasing the quality and scope of health coverage. Patients with health issues such as infertility, mental disorders, developmental delays and substance abuse issues have received essential care for these conditions where, prior to mandates, they may not have had covered benefits. Health insurance companies can no longer refuse coverage for pre-existing conditions, set lifetime limits on personal health care costs, or discriminate policy prices based on gender, age, health or lifestyle risk factors. Additionally, the mandates also help defray the onerous costs of unreimbursed emergency room care for uninsured patients who have conditions that low-cost preventive care could have avoided.
Opponents of the health insurance mandate argue that nearly every health insurance mandate ultimately increases the cost of an insurance policy. Depending on the structure of a mandate, it can increase the premium for a health policy by between one and five percent per mandate. Special interest groups, providers, and vendors lobby lawmakers to include or exclude a given benefit or service, and in doing so, the basic health insurance package is often expanded to include benefits such as breast reduction, contraception, erectile dysfunction, chiropractic care, and abortion. Since every citizen under PPACA regulations must pay for a policy that covers all mandatory basic services, every policyholder ultimately pays for services he doesn’t need or want. Opponents of these mandates argue they still shift the costs of out-of-pocket health care onto current insurance consumers by requiring everyone to pay for coverage for services some will never use.
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