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GAO-11-392R 1 (2011-02-25)

handle is hein.gao/gaobaanwr0001 and id is 1 raw text is: i ~GA 0 Accountability I Integrity * Reliability United States Government Accountability Office Washington, DC 20548 February 25, 2011 The Honorable E. Benjamin Nelson Chairman Subcommittee on the Legislative Branch Committee on Appropriations United States Senate Subject: Private Health Insurance Coverage: Expert Views on Approaches to Encourage Voluntary Enrollment Dear Chairman Nelson: To help expand health insurance coverage among the 50 million uninsured Americans, the Patient Protection and Affordable Care Act as amended (PPACA) mandates that individuals, subject to certain exceptions, obtain health insurance coverage or pay a financial penalty beginning in 2014-the individual mandate.' At the same time, PPACA generally requires insurers to accept all applicants, regardless of health status,2 and prohibits insurers from excluding coverage based on any preexisting conditions. An individual mandate such as PPACA requires has been the subject of continued debate. Many health care policy experts have stressed the importance of a mandate in expanding health care coverage and keeping premiums affordable. For example, experts have noted that such a federal requirement may be necessary to prompt many individuals, such as younger, healthier individuals, to obtain coverage they otherwise would forego-particularly once they are guaranteed access to that coverage later when they may need it. They suggest that bringing these younger, healthier individuals into the insurance market is necessary to avoid adverse 'Pub. L. No. 111-148, §§ 1501(b), 10106(b), 124 Stat. 119, 244, 909 (Mar. 23, 2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, §§ 1002, 1004, 124 Stat. 1029, 1032, 1034 (Mar. 30, 2010). Beginning in January 2014, individuals must maintain minimum essential coverage for themselves and their dependents, which includes employer-sponsored health plans, individual plans, and government-sponsored plans. Individuals must pay a penalty for each month they fail to comply with this mandate. Certain individuals, such as members of qualifying religious groups, are exempt from this mandate and other individuals, such as federal taxpayers whose household income is below the applicable filing threshold, are exempt from the penalty. 2For plan years beginning on or after January 1, 2014, PPACA requires health insurers offering group and individual coverage in a state to accept every employer and individual that applies for coverage in that state, subject to certain requirements. Pub. L. No. 111-148, § 1201(4), 124 Stat. 156. 3PPACA prohibits group health plans and insurers offering group and individual coverage from excluding coverage for any preexisting conditions. This prohibition is generally effective for plan years beginning on or after January 1, 2014 for adults and for plan years beginning on or after September 23, 2010 for individuals under age 19. Pub. L. No. 111-148, §§ 1201(2), 10103(e),(f), 124 Stat. 154, 895. GAO-11-392R Voluntary Health Insurance Enrollment

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