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Photo: Samuel Corum/Anadolu Agency/Getty Images

The Affordable Care Act’s insurance market has not been materially affected by the elimination of the individual mandate penalty — undercutting a key argument in the lawsuit urging the courts to strike down the health care law.

The big picture: Healthy enrollees have not left the market in droves, premiums have not spiked and there has been no market death spiral.

Details: Premiums spiked in earlier years, as insurers figured out the market and anticipated the elimination of the penalty, but are declining by an average of 2-3% in 2020.

  • Healthy people do not appear to have fled the market. ACA enrollees spent fewer days in the hospital in 2019 than in the previous four years.
  • The financial health of insurers participating in the ACA marketplaces is stable, and dramatically improved since the early years of the ACA. 
  • Other elements of the ACA, such as the Medicaid expansion, appear to have been largely unaffected by the elimination of the penalty.

Flashback: ACA historians will remember that many critics of the mandate believed the penalty was too weak to drive the healthy into the marketplaces from the start.

  • And real-world experience has shown that premium subsidies have been more important than the mandate penalty.

There are still well-documented problems in the individual market. 

  • Policies are unaffordable for many people who do not receive subsidies. Deductibles are very high (averaging $4,544 per person for a “benchmark” plan).
  • And insurer participation in some rural areas remains fragile.    

But these problems existed with the mandate penalty in effect.  

  • Experience on the ground has demonstrated that the marketplaces and the larger ACA continue to function, even when “severed” from the mandate penalty.

Go deeper

Four-day workweeks get rave reviews, but they're not catching on

Expand chart
Data: Indeed.com; Chart: Axios Visuals

The four-day work week is nowhere close to becoming the norm, despite a flurry of corporate announcements, media coverage and intense interest from worker bees worldwide.

Why it matters: With the pandemic throwing work-family dynamics into chaos and a labor market favoring workers, there's demand for this.

3 hours ago - World

Report: LGBTQ+ Afghans' lives "dramatically worsened" under Taliban rule

Taliban fighters in Kabul, Afghanistan, earlier this month. Photo: Mohd Rasfan/AFP via Getty Images

LGBTQ+ Afghans have been threatened, attacked and "faced an increasingly desperate situation and grave threats to their safety" since the Taliban seized control of Afghanistan last August, per a report published Wednesday.

What they're saying: "We spoke with LGBT Afghans who have survived gang rape, mob attacks, or have been hunted by their own family members who joined the Taliban, and they have no hope that state institutions will protect them," per a statement from study co-author J. Lester Feder.

5 hours ago - World

Canadian Indigenous group finds 93 suspected unmarked graves

A makeshift memorial honoring the 215 children whose remains were found in a mass grave in Brantford, Ontario, Canada, last May. Photo: Cole Burston/AFP via Getty Images

Indigenous leaders in Canada's western province of British Columbia said Tuesday they believe they've found 93 unmarked graves near a former boarding school.

The big picture: Hundreds of mass graves have been found at the grounds of former residential schools for Indigenous children since last May, when the remains of 215 children were uncovered at one such site in B.C.

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