**GAO-11-392R**                      Published: Feb 25, 2011. Publicly Released: Mar 25, 2011.                  

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## Highlights

To help expand health insurance coverage among the 50 million uninsured Americans, the Patient Protection and Affordable Care Act as amended (PPACA) mandates that individuals, subject to certain exceptions, obtain health insurance coverage or pay a financial penalty beginning in 2014--the "individual mandate". At the same time, PPACA generally requires insurers to accept all applicants, regardless of health status, and prohibits insurers from excluding coverage based on any preexisting conditions. An individual mandate such as PPACA requires has been the subject of continued debate. Many health care policy experts have stressed the importance of a mandate in expanding health care coverage and keeping premiums affordable. For example, experts have noted that such a federal requirement may be necessary to prompt many individuals, such as younger, healthier individuals, to obtain coverage they otherwise would forego--particularly once they are guaranteed access to that coverage later when they may need it. They suggest that bringing these younger, healthier individuals into the insurance market is necessary to avoid adverse selection, whereby disproportionately less healthy individuals who need health care services enroll in coverage, leading to higher premiums that further discourage healthy individuals from enrolling. Some experts have argued that the individual mandate does not go far enough to ensure that all of the uninsured enroll, and that to do so would require heavier penalties that are fully enforced to be truly effective. Other experts suggest that, rather than requiring individuals to obtain health insurance coverage, a more appropriate role for the federal government would be to consider alternatives to encourage voluntary enrollment. Some of these experts also question the legality of a federal mandate. Since its enactment, the federal mandate has been subject to a number of court challenges to its constitutionality. Because of the possibility that legislative or judicial action could result in a change to, or elimination of, the mandate, you asked us to identify potential alternatives to encourage, rather than require individuals to obtain private health insurance coverage. For this report, we obtained the views of multiple experts on the range of approaches Congress could consider to encourage voluntary enrollment in private health insurance coverage.

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## Topics

Health Care

Disadvantaged personsHealth care servicesHealth insuranceInsurance premiumsMedically uninsuredRatesHealth care reformPolicy evaluationFines (penalties)Access to health care