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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

Scoop: Stephanie Murphy announcing challenge to Marco Rubio

Rep. Stephanie Murphy. Photo: Tom Williams/CQ-Roll Call, Inc via Getty Images

Democratic Rep. Stephanie Murphy is planning to announce a campaign for the U.S. Senate in Florida against Republican Sen. Marco Rubio in early June, people familiar with the matter tell Axios.

Why it matters: Murphy is a proven fundraiser. Jumping in now would give her an early start to build her case for the Democratic nomination and potentially force Rubio and allied GOP groups to spend heavily to retain a seat in a state that’s trending Republican.

Inside the GOP's infrastructure strategy

Sen. Roger Wicker. Photo: Stefani Reynolds/Bloomberg via Getty Images

Top Republican senators are hoping the White House will make some sort of counteroffer to their infrastructure proposal when they meet with President Biden on Thursday, lawmakers and their aides tell Axios.

Why it matters: This is a sign of how serious the negotiations are, they say. In advance of the meeting, some of the senators are already publicly signaling the areas in which they have flexibility.

By the numbers: Senate seats to watch in 2022

Data: Axios Research, Dave Leip's Atlas of U.S. Elections; Chart: Andrew Witherspoon/Axios

While Republicans are giddy about their chances for regaining the House next year, GOP prospects for taking the Senate remain more uncertain, data reviewed by Axios suggests.

By the numbers: At least five Republican senators are retiring after the midterms, and four of their seats are in battleground states. That makes a simple Republican-for-Republican election exchange all the more difficult.

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