The individual mandate was often officially justified as being necessary to assure there was a sufficiently large risk pool with plenty people of average health. This of course was never the only way to achieve this goal. There were other options like automatically enrolling everyone who qualifies for a free plan.

The way the subsidies are structured a significant number of people qualify for the lowest quality “bronze” plans at no cost. As the New York Times recently highlighted:

Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs. [...]

The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.

The law could have been designed so that if any of these six million lower income people fail to choose an insurance plan on their own they would automatically be enrolled in the cheapest bronze plan in their area at zero cost to them.

While this is not an ideal policy for several reasons, it would likely guaranty that there was a large enough risk pool with a significant number of healthy individuals. For comparison the Obama administration has set themselves a goal of convincing only seven million people across all income levels to sign up on the exchanges this year to have a big enough pool.

Of course the best way to assure a solid risk pool would be to simply automatically enroll everyone into a quality insurance plan run by the government. This is why even though the exchanges have been so problematic the expansion of Medicaid has gone relatively well in several states.

Photo by TimmyGUNZ under Creative Commons license.