Who really has to purchase health insurance under the individual mandate?

Young Family

Most of the U.S. population is covered by an employer group or a family health insurance plan and will NOT have to purchase "New" insurance under the individual mandate of ACA.

A team of researches working with the Urban Institute, funded by the Robert Wood Johnson Foundation, determined that 73% of the U.S. population will not have to purchase health insurance because they are already covered. Their findings are reported in The Individual Mandate in Perspective, March 2012. PDF file version: The Individual Mandate in Perspective

Often times discussion of the individual mandate leads people to believe they will be forced to purchase health insurance, when in fact, they are already covered. A prime example is the 65 + year old population who are already covered by Medicare. Of the population not covered by Medicare, Medicaid, or incarcerated, it is estimated that over half of the population that will be subject to the individual mandate will be eligible for subsidies to purchase insurance.

What the study spot lights is that a small percentage of the U.S. population (approximately 7%) will actually have to purchase health purchase coverage because they currently have no coverage. The study assumed the Affordable Care Act was implemented in 2011 for the purpose of estimating the numbers.

Here are some of the highlights:

  • You are not subject to individual mandate if you are in Medicare or qualify for Medicaid.
  • You are not subject to the individual mandate if you are incarcerated or undocumented.
  • 94% of the U.S. population will not be required to buy health insurance because they are already covered by work, family or government program.
  • Only 6% of the U.S. population today will have to go out and purchase health insurance because of the individual mandate or face a penalty
  • 33% of people without health insurance will be exempt from individual mandate because of low income or local premiums are too high for their income.
  • People exempt from the individual mandate are economic hardship, religious objections, Native Americans and the incarcerated.
  • 86% of U.S. population subject to individual mandate already has health insurance. No change is required.
  • 43% of U.S. population subject to individual mandate has health insurance through a large employer group.
  • 12% of U.S. population subject to individual mandate has health insurance through a small group employer plan.
  • 7% of U.S. population subject to individual mandate has health insurance through a family member or previous employer.
  • 5% of U.S. population subject to the individual mandate has health insurance through an individual or family plan.
  • 17% of U.S. population subject to the individual mandate has health insurance through through public program: Medicaid, CHIP
  • 4% of U.S. population subject to the individual mandate will be eligible for Medicaid under reform expansion.
  • 6% of U.S. population subject to the individual mandate will be eligible for subsidies under the ACA reform.
  • 3% of U.S. population (non-Medicare) subject to the individual mandate will have to purchase affordable un-subsidized coverage through state exchanges.
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