Administering Health Insurance Mandates

Mandates form an integral part of many proposals to expand health insurance coverage. Often, however, too little attention is paid to how and whether they can be administered. The authors find that a mandate will be easier to administer when some or all of the following conditions are met: The mandate emphasizes facilitating compliance rather than penalizing noncompliance; It operates as a simple play-or-pay arrangement; It can accurately take advantage of regular withholding for most workers; It involves penalties that are moderate and collectable; It is coordinated with any subsidies and other public programs, including Medicaid; It is based upon other government payments that can be denied, such as tax benefits; It is applied only to those with more than low incomes, unless the penalty is denial of other benefits; Its size does not vary greatly with fluctuations in income, so any penalty can be collected currently and accurately.