States eye their own coverage requirements if individual mandate is repealed

If Republicans pass their tax cut plan as expected, including a repeal of the Affordable Care Act (ACA)’s individual mandate, Democratic-leaning states may respond with laws requiring their residents to buy health insurance or face a tax penalty.

POLITICO reports California, Connecticut, Maryland and New Jersey are among the states considering state-level mandate replacements to encourage younger, healthier customers to remain in the individual market risk pool. States that run their own insurance exchanges would be more likely to tackle the issue, despite the political risk in pursuing an unpopular requirement in an election year.

“If you get rid of the individual mandate, it’s bad for everything,” said Connecticut Lt. Gov. Nancy Wyman, a Democrat who chairs the board of the state’s exchange.

Before the ACA, other states had tried implementing ACA-like requirements, such as banning insurers from denying coverage based on pre-existing conditions, without a coverage mandate. In the case of New York and Washington, the result was a “death spiral” and rapid exit of insurers from the individual market. On a national scale, however, the Congressional Budget Office has said the exchanges would be stable without the mandate.

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