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Guaranteed-issue and individual mandate provisions imperative to success of health care reform

added April 7, 2011

One of the main purposes of the Patient Protection and Affordable Care Act is to assure that all Americans have access to health insurance, including those who have a pre-existing condition. The law requires insurance companies to provide what is called "guaranteed-issue" coverage, meaning that insurers can not deny coverage based on past illnesses or current health conditions.

One of the early reforms required health insurance plans to guarantee-issue coverage for children under the age of 19; the elimination of pre-existing conditions for all adults takes effect in 2014.

Any requirement for insurers to guarantee coverage to all comers must be coupled with a strong incentive for all Americans to carry health insurance. A financially stable health insurance pool is one that has in it people who are healthy and do not require many services as well as people who are sick and need services. The system will not work well if people can wait until they are sick to purchase coverage; if that were the case, the cost of health insurance for all Americans, including those who already have insurance, would rise.

PPACA includes a mandate requiring all individuals to carry health insurance aimed at getting most people in the insurance pool. This individual mandate is at the center of several court cases testing the law's constitutionality. While the courts determine the constitutional issues, other options must be explored to determine if there is a better way to encourage Americans to carry health insurance. This might include a stronger incentive rather than a penalty; defined open enrollment periods; higher premium costs for those who do not purchase insurance at their first opportunity, and other mechanisms to keep people in the system, rather than freely moving in and out.