The 2017 Tax Cuts and Jobs Act reconciliation bill was mostly a corporate tax cut. It also zero-ed out the individual mandate penalty for not having creditable coverage starting on January 1, 2019. The Republican Congress wanted to reduce the strength of the mandate as the Congressional Budget Office modeling suggested that the mandate was fairly effective in getting people into coverage so the extra subsidy expenses swamped the incremental revenue. Eliminating the penalty attached to the mandate would free up several hundred billion dollars for more upper income corporate tax cuts at the cost of several million more person-years of uninsurance.
Several states including New Jersey and Massachusetts responded to this federal policy change by either implementing or restarting state based coverage mandates that went live on January 1, 2019.
A new paper in Medical Care written by Onyinye and colleagues used two different methods to see if the state based mandates had any impact on enrollment. They used first synthetic controls and then a difference in difference approach. Both methodological choices produced similar results:
Changes in any coverage, individually purchased coverage, and employer-sponsored coverage rates are relatively small (generally in the range of 1–2 percentage points) and statistically nonsignificant in both Massachusetts and New Jersey ….. there is no discernable difference by eligibility for marketplace subsidies based on income level in the ACS data….estimates for changes in marketplace enrollment are … statistically nonsignificant.
TLDR: NOTHING HAPPENED
I know a couple of other papers are working their way through the publication pipeline right now. They use different data and methods to find similar results.
From a policy perspective, the individual mandate seems to have modest enrollment effects early on. It seemed to be more effective on men then women. The actual mandate penalty was often far less than the statutory penalties. Not too many people were exposed to it. The CBO always thought that the mandate mattered a lot even as some research found more of a “taste for compliance” than financial effects in play. However by 2019, the current research is showing that its marginal enrollment effect is not detectable when it disappeared in most states.
There is an argument to make that people systemically mistimed the disappearance of the mandate for the 2018 plan year instead of the 2019 plan year as the messaging in the fall of 2017 was that the mandate was going away and it would make OBAMACARE DEAD DEAD DEAD. If you give spot me three beers, I may make that argument with serious conviction. Let me get to my fourth beer, so I can argue that Silverloading overwhelmed any plausible mandate repeal effect by the vast increase in proliferation of zero or near zero plans for subsidized enrollees by 2019 so whatever small effect that we could expect to see with a federal mandate zero-ing out was being swamped by massive policy changes elsewhere. But these are stretches given the current and emerging evidence. The mandate by 2019 probably was not doing much to encourage enrollment and coverage.
Anonymous At Work
Sounds like the mandate, even without a penalty, got people onboard (Please note that men needed to be forced, women were already volunteering), and then INERTIA, that great [lack of] force in regulatory law and human behavior, seems to have kept people enrolled.
Ironically, repealing Obamacare and replacing it with an identical Trumpcare, would have only shown marginal effects at most for the same reason.
NASA, why are you trying to prevent human extinction again?
Yutsano
Maybe. The biggest problem with the mandate was it wasn’t enforceable. If you never paid it all the IRS could do is wait for your next refund to take any money to cover whatever Shared Responsibility Payment a taxpayer had. I would see an SRP languish on an account because someone would owe consistently and we were mandated to collect the tax* first. So the SRP just sat there doing nothing but lurking. Fuck Republicans.
*yes I’m aware that’s my agency’s first mission. But if Congress is gonna make us in charge of this shit then let us actually do what we do pretty damn well: get money from people.
Major Major Major Major
Interesting!
Feathers
Or recognize that at this point a lot of the people not signing up for insurance are those with cognitive dysfunction and piling an extra monetary disaster on top of not having insurance is just kicking the poors because you can.