The Individual Mandate in Perspective

If the ACA were in effect today, 94 percent of the total population (93% of the nonelderly population) or 250.3 million people out of 268.8 million—would not face a requirement to newly purchase insurance or pay a fine.

The “individual mandate”—the requirement that individuals either have health insurance coverage or pay a fine—is both the best known and the least popular component of the Affordable Care Act (ACA).

In this brief, the authors use the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to estimate the number and share of Americans potentially subject to the mandate, identify their insurance status absent the ACA, and simulate eligibility for Medicaid and exchange-based premium and cost-sharing subsidies. To allow the most direct comparison of postreform coverage with coverage absent reform, their analysis treats the provisions of the ACA as if fully implemented in 2011. The results of their analysis are presented in a table format—with estimates of the population exempt from the mandate; the population potentially affected by the mandate but already covered by insurance of some type; and the remaining population required to newly purchase coverage or pay a fine.