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A new paper by the CT Health Policy Project outlines why an individual mandate, a law requiring every state resident to purchase health coverage won’t work. (For the shorter issue brief, click here.)

Mandates are no guarantee of compliance; CT requires drivers to have auto insurance but 12% of drivers are uninsured. Unreimbursed care for the uninsured is only a very small part of health care spending (2%), so it won’t solve our skyrocketing health cost problems. Very few people choose to be uninsured, most uninsured can’t afford coverage. CT is one of the most expensive places to buy health insurance; between 2000 and 2007, premiums in CT rose 8.2 times faster than our incomes. There is a lot of inadequate insurance for sale, our state regulatory agencies don’t do enough to protect consumers and ensure that they are getting their money’s worth. Health coverage is no guarantee of access to care – ask any HUSKY family. Connecticut cannot afford to build the state bureaucracy necessary to enforce an individual mandate, and there are far more efficient ways to use that money to improve CT’s health. And an individual mandate would invite legal challenges that CT also cannot afford.

Other states considered an individual mandate and decided against it including Maine and Vermont. It is too early to say whether MA’s individual mandate is working or not; penalties only become significant this April. California’s health reform proposal failed last year largely due to an individual mandate. One Senator, answering why he decided to vote against it, said, “I just came to the conclusion that the working people are going to end up paying for it. There’s control for everybody else – the employers are protected and the insurance industry. The only group that’s vulnerable is the working people.”

An individual mandate does nothing to address the real problems behind our broken health care system – too many incentives to over-treat, too few incentives for quality care, not enough emphasis on prevention and chronic care management, and fragmented payment systems that foster cost shifting. In fact, designing and administering an individual mandate would distract precious attention and resources away from solving the real problems with our health system.
Ellen Andrews