• Is the mandate penalty large enough?

    Earlier this week, David Nather of POLITICO reported that health insurers are telling the Obama Administration that the penalty for not having coverage will not be sufficiently large to encourage enough healthy people to sign up. However, if the goal is to avoid a destabilizing level of adverse selection, the best evidence we have is that it may be, when fully phased in, just fine. My latest post on the JAMA Forum goes over some of that evidence.


    • An issue with that paper is the one that you identify “Massachusetts differs from the rest of the country in many ways, so one should be cautious about making generalizations.” This could especially be a problem in areas of the country which are adamantly opposed to “Obamacare.”

      I wonder if limited open enrollment periods or delays in starting coverage would be useful and whether they could be implemented by regulation (rather than legislation). They would clearly be more useful against the person who buys coverage while having a heart attack or other emergency rather than needed cancer care or other longer term illness.

      • I hear you. But what is the right politically viable penalty level to avoid a selection problem? The evidence is scarce, but the politics are fairly clear. That’s the real culprit to encouraging greater enrollment. Demagogue the law and you’ll have some trouble even at a higher penalty level.