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Experts almost universally agree repealing the individual mandate is bad for the marketplace. Photo: Carolyn Kaster/AP

Experts across the political spectrum generally agree that the Affordable Care Act's individual mandate is both necessary for market stability, and probably not working as well as its authors intended.

The bottom line: Almost everyone agrees that repealing the mandate now, without a replacement, will make insurance markets function substantially worse than they are today. But many experts believe other policies might be just as effective, if not more so, at getting healthy people into the system and thus moderating premium increases.

While there's disagreement about how effective the mandate has been, most people I talked to acknowledge that it's not working as well as originally intended, and some conservative health wonks think there are more effective ways of getting more young, healthy people into the market.

  • "There is real uncertainty about the precise magnitude of the effects of repealing the mandate—as there is about almost any change in public policy—but little uncertainty that doing so would result in many more uninsured and a worse health care system," said Matt Fielder of the Brookings Institution.
  • "The mandate wasn't very strictly enforced, the penalty is pretty low by most people's standards, and it comes a year after dropping coverage, if it comes," Joe Antos of the American Enterprise Institute told me.
  • "Putting aside whether the mandate is actually effective, insurers think it is effective—and in many ways that's what counts. If insurers think it's effective, then they won't jack up premiums—which means it is effective," the Center for American Progress Topher Spiro said.
  • Potential alternatives include auto-enrolling people into coverage, imposing a penalty on those who don't have continuous coverage when they sign up, creating a federal reinsurance pool to offset the cost of sick enrollees, increasing the mandate penalty.

What we know about the mandate's effectiveness:

  • Enrollment through the ACA's exchanges has been lower than predicted. There are many potential reasons for this, but the mandate being a weak incentive is one.
  • S&P Global estimated last week that repealing the mandate would result in 3 to 5 million more uninsured people than the status quo — a far cry from the 13 million predicted by the Congressional Budget Office.
  • Yet, as Fiedler points out, the uninsured rate among people who are too wealthy for the ACA's premium subsidies fell by around one-third as the ACA took effect. "That trend is very hard to explain unless the mandate has had a significant effect on insurance coverage decisions since these individuals are not eligible for subsidies or Medicaid expansion."

Go deeper

Updated 7 hours ago - World

Mexican President López Obrador tests positive for coronavirus

Mexico's President Andrés Manuel López Obrador during a press conference at National Palace in Mexico City, Mexico, on Wednesday. Photo: Ismael Rosas/Eyepix Group/Barcroft Media via Getty Images

Mexican President Andrés Manuel López Obrador announced Sunday evening that he's tested positive for COVID-19.

Driving the news: López Obrador tweeted that he has mild symptoms and is receiving medical treatment. "As always, I am optimistic," he added. "We will all move forward."

7 hours ago - Politics & Policy

Sarah Huckabee Sanders to run for governor of Arkansas

Sarah Huckabee Sanders at FOX News' studios in New York City in 2019. Photo: Steven Ferdman/Getty Images

Former White House press secretary Sarah Huckabee Sanders will announce Monday that she's running for governor of Arkansas.

The big picture: Sanders was touted as a contender after it was announced she was leaving the Trump administration in June 2019. Then-President Trump tweeted he hoped she would run for governor, adding "she would be fantastic." Sanders is "seen as leader in the polls" in the Republican state, notes the Washington Post's Josh Dawsey, who first reported the news.

Coronavirus has inflamed global inequality

Illustration: Aïda Amer/Axios

History will likely remember the pandemic as the "first time since records began that inequality rose in virtually every country on earth at the same time." That's the verdict from Oxfam's inequality report covering the year 2020 — a terrible year that hit the poorest, hardest across the planet.

Why it matters: The world's poorest were already in a race against time, facing down an existential risk in the form of global climate change. The coronavirus pandemic could set global poverty reduction back as much as a full decade, according to the World Bank.