A defense of the employer mandate

I’m on record over at the JAMA Forum (and elsewhere) as to being lukewarm about the employer mandate. You can go read me over there to understand why. A recent Viewpoint at JAMA makes the argument for the mandate, however:

The core value undergirding the shared responsibility principle is the realization that all of the major stakeholders of the health care system must contribute something if comprehensive health care reform is to be accomplished. Stated differently, making the ACA work requires a measure of responsibility from consumers, hospitals, physicians, insurance companies, drug makers, medical device makers, home health agencies, labor, and—because of section 1513—large employers. This same notion proved essential in the passage of the 2006 Massachusetts Health Care Reform Act that served as a partial model for the ACA. Indeed, despite “employer shared responsibility payments” limited to $295 per uninsured employee per year, a far lower contribution than that required by the ACA, Massachusetts continues to lead the nation in the provision of employer-sponsored health insurance.2 Without some form of shared responsibility, an important principle of health reform will be abandoned.

Shared responsibility is a public good, especially for employers who might otherwise be inclined to shift the cost of employer-sponsored health insurance onto the federal government and thereby the taxpayers. It follows that the employer mandate provision has a meaningful role to play in preserving employer-sponsored health insurance.

I’m still not convinced we couldn’t find a better way to achieve these goals, but McDonough and Adashi aren’t wrong. Go read the whole thing.


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