A health insurance mandate is an employer or an individual's mandate to obtain private health insurance rather than (or in addition) a national health insurance plan.
Video Health insurance mandate
Australia
Australia's national health insurance program is known as Medicare, and is financed by general tax including Medicare levies on income; the use of Medicare is not mandatory and those who purchase private health insurance get government-financed price discounts for premiums. Individuals with high annual income (A $ 70,000 in the 2008 federal budget) who do not have a certain private hospital coverage rate are subject to 1% Medicare Levy Surcharge. People who earn an average and below may qualify for subsidies to buy personal insurance, but do not face punishment for not buying it. Private insurance companies must comply with guaranteed issues and community ranking requirements, but may limit the scope of existing illnesses by up to a year to prevent adverse elections.
Maps Health insurance mandate
Japanese
Japan has a universal health care system that requires all residents to have health insurance, either at work or through a local community-based insurance company, but does not penalize individuals for not having insurance. Japan's health ministry "tightly controls the price of health care to the smallest detail Every two years, doctors and health ministries negotiate a fixed price for each procedure and every drug that helps keep the premium around $ 280 per month for the average Japanese family." Insurance premiums are set by the government, with a guarantee of problems and community ratings. Insurers are not allowed to refuse claims or coverage, or to gain a profit (net income is taken to the next year, and if the carryover is large, the premium falls). Approximately 10% avoiding mandatory insurance premiums; city ​​authorities do not issue them insurance cards, which require providers. Private voluntary insurance is available through several sources including employers and unions to cover expenses not covered by legal insurance, but this accounts for only about 2% of health care spending. In practice, doctors will not refuse patient care in a universal system at a low price because they constitute a large majority of national patients, and doctors will not be able to generate enough by serving only a small number of patients with private insurance. Total spending is about half the American level, and taxpayers subsidize the poor.
Netherlands
The Netherlands has a health insurance mandate and allows non-profit firms to compete for minimum coverage insurance plans, although there are also joint insurance so the use of commercial insurance for profit is not mandatory. The government regulates insurance companies and operates a risk equalization mechanism to subsidize insurance companies that insure relatively more expensive customers. Some features suppress premium rates that facilitate public compliance with the mandate. Health care costs in the Netherlands are higher than the European average but less than in the United States. Half of the insurance fee for an adult is paid by taxes related to the income used for private insurance subsidies through a risk reinsurance pool operated by the regulator. The government pays all fees for children. Forty percent of the population is eligible for premium subsidies. Approximately 1.5 percent of the legal population is estimated to be uninsured. The architects of the Dutch mandate did not imagine any problems with non-compliance, the early legislation created some effective sanctions if one did not take out insurance or pay a premium, and the government is currently developing a law enforcement mechanism.
Switzerland
The Swiss system is similar to the system in the Netherlands with private insurance companies arranged to compete to provide the minimum coverage required to fulfill its mandate. Premiums are not related to income, but the government provides subsidies to lower-class individuals to help them pay for their plans. Approximately 40% of households received some kind of subsidy in 2004. Individuals are free to spend as much as they want for their plans and purchase additional health services if desired. The system has virtual universal coverage, with about 99% of people having insurance. The laws behind the system were created in 1996. The latest issue in the country is the rising cost of their health care, which is higher than the European average. However, the increase in costs is still slightly less than an increase in the United States.
United States
History
The individual mandate to purchase health care was originally proposed by the politically conservative Heritage Foundation in 1989 as an alternative to single payer health care. Stuart Butler, an early supporter of the individual's mandate at the Heritage Foundation, writes:
If a young man destroys his Porsche and has no foresight to get insurance, we may sympathize, but the public does not feel obliged to improve his car. But health care is different. If a man has a heart attack on the road, the American will care about him whether he has insurance or not.
The Heritage Foundation changed its position in 2011, calling the individual mandate unconstitutional.
From the outset, the idea of ​​an individual's mandate was championed by Republican politicians as a free-market approach to health care reform. Supporters include Charles Grassley, Mitt Romney, and the late John Chafee. The individual's mandate is felt to resonate with the conservative principles of individual responsibility, and conservative groups recognize that the health market is unique.
In 1993, President Bill Clinton proposed a health care reform bill that included a mandate for employers to provide health insurance to all employees through markets administered by health maintenance organizations and individual mandates. However, Clinton's plan fails amid fears that it is too complex or unrealistic, and in the face of an unprecedented series of negative ads funded by conservative political and health insurance industry groups. At that time, the Republican Senator proposed a bill that would require individuals, and not employers, to buy insurance, as an alternative to Clinton's plan.
Hillary Clinton's plan in 2008 also includes an individual's mandate.
Massachusetts
Individual health insurance mandates were initially enacted at the state level: Massachusetts healthcare reform legislation 2005. In 2006, Republican Mitt Romney, the governor of Massachusetts, signed individual mandates into law with strong bipartisan support. In 2007, a Senate bill featuring a federal mandate, written by Bob Bennett (R-UT) and Ron Wyden (D-OR), attracted great bipartisan support. By 2016, more than 97 percent of Massachusetts's population is insured, making it the country with the lowest percentage of people without health insurance.
Before the law was passed, the per capita health care cost in Massachusetts was the highest for every part of the country except DC From 2003 to 2008 (three years before and two years after the entry) the Massachusetts insurance premium continued beyond the rest of the United States, but the growth rate of year to year for Massachusetts has slowed as a result of the law.
New Jersey adopted an effective individual health insurance mandate January 1, 2019, while other countries provide community ratings and guaranteed issues without a mandate.
Affordable Care Act
Romney's success in installing an individual mandate in Massachusetts was initially praised by Republicans. During President Romney's 2008 campaign, Senator Jim DeMint (R-SC) praised Romney's ability to "take some good conservative ideas, such as private health insurance, and apply them to the need to have everyone insured." Romney himself says of the individual's mandate: "I am proud of what we have done, and if Massachusetts succeeds in implementing it, it will be a model for the nation." In the campaign of President of Senator 2008 Barack Obama campaigned against the mandate of the individual. Obama attacked Hillary Clinton and John Edwards for their support of the individual's mandate during the primary debate and in television commercials.
However, following the adoption of the mandate of individuals as a major component of the Patient Protection of President Obama and the Affordable Care Act in 2009, Republicans began to oppose the mandate. In 2009, every Republican Senator (including Bennett, who had co-authored the 2007 bill mandating the bill) chose to describe the mandate as "unconstitutional". (Describing his opposition, Bennett then said: "I do not focus on the specific things of the amendment as closely as I should, and would probably choose in another way if I understood that the individual's mandate was essentially.I just wanted to express my opposition to the proposal Obama at every opportunity. ") The New York Times writes:" It may be difficult to remember now, given the ferocity that many Republicans use as an attack on freedom, but the provision in President Obama's health care law that requires all Americans to buy insurance health is rooted in conservative thinking. "
Other Republican politicians who previously supported the individual mandate, including Romney and Orrin Hatch, alike emerged as vocal critics of the mandate in Obama's law. Writing in The New Yorker , Ezra Klein states that "the end result is... a policy that once enjoyed widespread support in Republicans suddenly facing a united opposition."
The Affordable Care Act signed in 2010 by Obama includes an individual's mandate to take effect in 2014.
On 30 August 2013, the final rule for the individual mandate is published in the Federal Register (78 FR 53646), with a small correction published December 26, 2013 (78 FR 78256).
With a Tax Discount and Jobs Act of 2017, the individual's mandate of the Affordable Care Act is effectively lifted 2019.
Constitutional challenge
The mandate of the ACA was challenged in federal court by the Attorney General of the Republic. On June 28, 2012, the US Supreme Court upheld the provision as the Constitution. Supreme Court Justice John Roberts conveyed a majority opinion in the Independent National Federation of Business v. Sebelius , which upholds the Patient Protection and Affordable Care Act with 5-4 votes. The Court ruled that although the "individual" mandate component of the act was unconstitutional under the Trade Clause, it was reasonably interpreted as a tax and therefore applies under the authority of Congress to "lay down and collect taxes."
There is also disagreement about whether a federal mandate can be constitutional. In 2010, the majority of the 50 states filed lawsuits that the individual's mandate was unconstitutional, and the newly elected Republican governor of the campaign promised to add their state to the list in 2011. The federal district court was initially divided into issues of constitutionality, which in the end is expected to reach the Supreme Court; also, the legislative acts of the state can at least lead to delays. The Militia Acts of 1792, based on the clause of the Constitutional militia (in addition to its affirmative authorization to appoint the army and navy), would require every "wholesome, white male male" between the ages of 18 and 45, with some exceptions to " giving himself "weapons and ammunition; However, it was never enforced so that its constitutionality was never prosecuted. In 1994, the Congressional Budget Office issued a report describing the individual's mandate as "an unprecedented form of federal action." The agency also wrote, "The government never requires people to buy any goods or services as legitimate conditions of residence in the United States."
In a September 2010 paper, an upcoming article in the NYU Journal of Law and Liberty, and a lecture given at NYU, Randy Barnett of Georgetown University Law Center argues that the mandate is unconstitutional under the Necessary and Appropriate Trade and Clause doctrine, and that enforcing it is equivalent to "confiscating people." Punishing inaction, he argues, can only be sustained when a person's basic task has been established. He also asserted that Congress failed to enforce its mandate under its tax authority because its punishment did not generate revenue according to the Act itself.
The decision of the US Supreme Court to enforce the individual mandate was granted in June 2012, in the case of the National Independent Business Federation v. Sebelius .
Criticism of individual mandates
Insurance lobbyists (AHIP) in the United States advocate that mandates are needed to support the issue of guarantees and community ratings, which limit the guarantee by insurance companies; the insurance company proposes that this mandate is intended to prevent reverse selection by ensuring healthy individual purchase insurance and thereby expanding the risk group. The mandate has been considered at the heart of healthcare reform proposals in the United States and an "absolutely necessary" prerequisite for universal health care, as any non-compulsory reforms will fail to expand coverage. The AHIP/Kaiser 2008 Forum cites the Dutch and Swiss mandates (see below); The report published by AHIP does not mention the punishment but says Switzerland "enforces the rules in many ways..." In October 2009, Kaiser Health News reported that "The insurance industry is clearly worried about the mandates being eliminated."
Some studies of empirical evidence suggest that the threat of inverted selection is exaggerated, and that risk aversion and favorable selection can balance it. For example, some US states have guaranteed issues and rating limits, but only Massachusetts has an individual mandate; even though Japan has a nominal mandate, about 10% of individuals are disobedient, and there is no penalty (they remain uninsured - see below). Without a mandate, non-profit insurance companies always rely on risk aversion to charge premiums on expected risks, but have been limited by what customers are willing to pay; mandates eliminate the constraint, allowing insurance companies to charge more. Governments that impose mandates must subsidize those who can not afford, thus shifting costs to taxpayers.
The insurance mandate faces opposition across the political spectrum, from left-leaning groups such as the Green Party and other single-paying health promoters to right-leaning groups like the Warisan Foundation, FreedomWorks, and the Cato Institute as well as some members. US Senate and House of Representatives.
Opponents such as Michael Cannon, Director of Policy Studies at the Cato Institute, make philosophical arguments that people should have the right to live without government social interference as a matter of individual freedom. He has stated that federal, state and local governments are unwilling or able to raise the necessary funds to effectively subsidize people who are currently unable to afford insurance. He also stated that the cost to increase coverage is much higher than for other reforms, such as reducing the number of errors and accidents in care, which will achieve as much or more benefits for the community.
Public opinion polls from 2009 to 2012 continue to find that most Americans refuse to punish people for not buying health insurance.
Company mandate
In the United States, the Patient Protection and Affordable Care Act (PPACA) covers both employers and individual mandates in force in 2014. The mandate of a PPACA employer requires that all businesses with 50 or more full-time employees provide affordable minimum health insurance for most 95% of full-time employees and dependents up to the age of 26, or paying expenses in 2016. In the two largest EU countries, France and Germany, Statutory Health Insurance (SHI) mandates employers and employees paying into disease funds under the law, invite. In France, private health insurance (PHI) is voluntary and is used to increase the rate of replacement of the disease system based on law. The same applies in Germany where it is also possible to opt out of the SHI if you earn very high and become a PHI but if someone has reached the age of 55 years and is in the PHI sector, he must remain protected by IRC. and can not vote back to SHI. Unemployed people can usually resume their payments through social insurance and very poor people receive government support for insurers. Most workers are insured through a compulsory membership "illness fund" which is a non-profit body established initially by unions and is now given legal status. In Germany and France, as with most European health care finances, private contributions to health care finance vary according to one's income level and do not match their health status. Only 0.2% of uninsured Germans, especially self-employed, rich and poor, and people who have failed to pay contributions to insurance or legal premiums for private health insurance. Between 1990 and 2000, the share of French SHI revenue that came directly from employees through salaries fell from about 30% to just 3% and the employer's direct contribution also fell. The difference is due to increased revenue from government taxes, thereby expanding the base of mandatory contributions to the health insurance system.
See also
- Individual shared responsibility terms
References
External links
- Individual Mandate for Health Insurance - Slippery Slope to National Health Care
- Arguments for employers mandate
Source of the article : Wikipedia
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