Nine states are considering the addition of an individual mandate to buy health insurance coverage.
The Hill reports that such a move is underway less than two months after the passage of the tax law also swept away the individual mandate for the Affordable Care Act.
The individual mandate was put in place as a means of keeping the lid on premiums by making everyone have health coverage. Its proponents point out that without it, healthy people tend not to buy coverage, and that causes premiums to increase for people who need insurance the most. Republicans, on the other hand, object to the notion that everyone should be compelled to have health insurance.
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The Wall Street Journal reports that Maryland lawmakers are pursuing a plan to replace the ACA mandate with one of its own. And it's not alone; California, Connecticut, Hawaii, Rhode Island, Washington, Minnesota, New Jersey and Vermont, as well as the District of Columbia, are all considering a similar push.
Such moves to require health care coverage by some states could indicate a shift of authority over health care from the federal government to the states, says The Hill, "possibly leading to significant coverage differences between red states and blue states." And it could, as the WSJ points out, "redefine access and coverage for millions of consumers.'
The ACA established a floor of coverage for everyone, with minimum standards including coverage of hospitalization, maternity care and mental health as well as a bar against denying coverage due to preexisting conditions. Various actions and reversals of Obama-era policies by the Trump administration have tattered that safety net, and the move by blue states to preserve ACA protections against Republican efforts in red states to eliminate them could, according to the WSJ report, "see a growing gulf on issues such as Medicaid benefits, consumer protections, insurer regulations, and the availability of cheaper, less-comprehensive health plans, health analysts say."
"The hodgepodge of congressional actions and administrative efforts have really shifted activity to the states on a whole range of health care issues," Larry Levitt, a senior vice president at the Kaiser Family Foundation, is quoted saying. "We're moving back to when coverage and consumer protections vary tremendously."
According to the Congressional Budget Office, repeal of the individual mandate alone will result in millions of people dropping or losing coverage. The report says that it's possible more insurers will remain on the exchanges in states that have a mandate, since that will give them a more predictable mix of both healthy and ill customers.
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