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Individual Mandate for Health Insurance Affordable and Fair

Last Updated: June 17, 2009.

Reforming the health insurance market so that all individuals are required to obtain at least a minimum amount of health insurance would eliminate the problem of adverse selection that the current system enables insurers to avoid, according to a perspective published online June 17 in the New England Journal of Medicine.

WEDNESDAY, June 17 (HealthDay News) -- Reforming the health insurance market so that all individuals are required to obtain at least a minimum amount of health insurance would eliminate the problem of adverse selection that the current system enables insurers to avoid, according to a perspective published online June 17 in the New England Journal of Medicine.

Linda J. Blumberg, Ph.D., and John Holahan, Ph.D., from the Urban Institute in Washington, D.C., write that the consequence of the current system is a health care system segmented according to health risk rather than being focused on providing efficient access to high-quality medical care.

Requiring everyone to have at least a set minimum level of health insurance would eliminate adverse selection, poor health would no longer prevent people from obtaining insurance, and public funds currently spent protecting the uninsured could be redirected to finance a system based on income-related subsidies, the authors argue.

"Enforcement of the mandate is the final issue. Once adequate subsidies exist, enforcement is essentially a matter of fairness to people who are playing by the rules. We believe enforcement through the tax system is the most efficient approach," the authors write. "An enforceable individual mandate, with adequate subsidies and benefits, as well as a choice of plans, is the most politically feasible route to universal coverage in the United States today."

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