How do you force everyone to have health insurance?

Kansas City StarSeptember 2, 2009 

If health care reform occurs, it is likely to include an individual mandate — a requirement that every American have health insurance.

In theory, health coverage would work something like the requirement that drivers buy auto insurance.

But everyone knows someone who has been hit by an uninsured, and sometimes even an unlicensed, driver.

So just how would an individual health insurance mandate work?

“I have difficulty understanding how we’d police the mandate,” said Truman Medical Center Chief Executive John Bluford. “It’s near impossible. People will game the system.”

Even so, an individual mandate appears to be the best way to ensure coverage for the most people.

The three major reform proposals under consideration in Congress each would require individuals to buy a minimum level of health insurance if they are not covered through an employer-based plan and if they are not eligible for low-income or older-American subsidized care.

The individual mandate would be accompanied by public subsidies for those who couldn’t afford the price of health insurance, whether on the open market, through an insurance exchange or from a government option.

Complicated formulas would set those subsidy levels based on household incomes.

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