How’s the Individual Mandate Doing?

by Dave Schuler on March 27, 2014

Here’s an interesting little factoid:

The individual mandate had the least effect on those it was supposed to encourage to gain coverage—the uninsured. McKinsey & Co. surveys found that a little over one-quarter of people signing up for coverage last month were previously uninsured. Goldman Sachs analysts estimate that about one million uninsured Americans will sign up for the ObamaCare exchanges before open enrollment ends. For perspective, that’s about 2% of the 48 million uninsured.

That sounds like an awful lot of energy, time, and money expended to insure .3% of the people. Do you think the additional costs will be linear or geometric to insure the reamining 16%?

{ 15 comments… read them below or add one }

... March 27, 2014 at 12:48 pm

If not as many people are signing up, shouldn’t the cost of the program come down with the smaller number of subsidies?

... March 27, 2014 at 12:49 pm

Other than pure government waste, I don’t see how this shouldn’t be a significant cost savings. What am I missing?

PD Shaw March 27, 2014 at 1:34 pm

I’m not sure this is surprising; I think there were CBO estimates presented during the initial debates that found a range of impacts from the individual mandate, the lower-end of which were pretty inconsequential. The argument appears to be that Massachusetts, though different in significant ways, was low, and it more or less improved sign-up. I think this argument overlooks the fact that not all Americans are from Massachusetts, and different cultures in different parts of the country vary on rule compliance for its own sake.

steve March 27, 2014 at 2:12 pm

The rest of the country may not be Massachusetts, but the assumption has always been that people want health care, and in first world countries that means health care insurance.


PD Shaw March 27, 2014 at 2:23 pm

@steve, then the individual mandate is not needed?

... March 27, 2014 at 2:33 pm

The rest of the country may not be Massachusetts, but the assumption has always been that people want health care, and in first world countries that means health care insurance.

The most expensive healthcare I ever received came when I didn’t have insurance.

Dave Schuler March 27, 2014 at 2:48 pm

Well, PD, the word “want” covers a lot of territory. By my standards if you aren’t willing to do what is necessary to get something including pay for it, you don’t want it. Relative priorities, measured by willingness to pay, are not something that most people understand.

steve March 27, 2014 at 6:17 pm

PD- Not really. There are ways around it, though it is easier than most other ways to increase coverage. SOme people disagree.


Andy March 27, 2014 at 6:26 pm


I think the assumption that people want healthcare is basically correct. However, as with anything else, wants are always subject to cost-benefit calculations and health care (as well as HC insurance) is expensive.

Dave Schuler March 27, 2014 at 6:44 pm

I think the assumption that people want healthcare is basically correct.

That’s not the question. I think we’re in agreement that people want access to healthcare. The question is whether the uninsured want healthcare insurance. Judging by the response, it certainly looks as though the answer is “no”.

steve March 27, 2014 at 7:57 pm


Maybe better phrased as want health care enough to pay for it. In the US (and most of the world) that means insurance.


jan March 27, 2014 at 7:59 pm


Many if not most people like to chose their own HC services, rather than being limited by excessive government criteria and/or HC exchanges that shrink their options under the burden of regulations denoted in the PPACA — some 20,000 pages worth!

My friend’s daughter, in her last trimester of pregnancy, was given a shock the other day after she discovered the physician referral given to deliver her baby, is not in her HC exchange. She is now going to be on the hook for $20,000 worth of out-of-pocket medical expenses — an amount she can ill afford at this time. She came back from her obstetrical appointment in tears.

Andy March 27, 2014 at 8:48 pm


Well sure, but cost is a big factor. As long as health care remains expensive so will insurance. Most people, I think, don’t really realize how expensive it is because they never see the costs. This is particularly true of employer-provided insurance – I think many are only aware of deductibles.

TastyBits March 27, 2014 at 11:47 pm


Your friend’s daughter should try to negotiate with the different companies. Some will discount the price if you pay in one cash payment. The other thing your friend can do is to “pass the hat” around to family and friends.

jan March 28, 2014 at 11:29 am

Good ideas, Tasty…

This young woman’s Mom called me as I was in the parking lot of a building supply place. The conversation couldn’t go on too long or in too much detail, however, I did grasp the measure of distress this was causing not only the young Mom but her family as well. Hopefully there can be some kind of negotiations, either with the insurance company or physicians, that can lower the charges. The family will do what they can as well. But, they are not ‘rich.’ Also, my husband and I will pitch in too, as we think of our friend’s daughter as part of our family too.

I just wonder how many times similar stories will be played out in families across the country, when the revelations of the PPACA hit their own lives — be it not having the services their conditions call for, or having such high deductables that it puts them in financial jeopardy.

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