The minimum coverage provision, or individual mandate, is a provision under the 2010 Affordable Care Act (ACA). According to a short paper recently issued by The Robert Wood Johnson Foundation and the Urban Institute, if the ACA were in effect today, 94 percent of the total population (93% of the nonelderly population) or 250.3 million people out of 268.8 million—would not face a requirement to newly purchase insurance or pay a fine. In this brief, the authors use the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to estimate the number and share of Americans potentially subject to the mandate, identify their insurance status absent the ACA, and simulate eligibility for Medicaid and exchange-based premium and cost-sharing subsidies. To allow the most direct comparison of postreform coverage with coverage absent reform, their analysis treats the provisions of the ACA as if fully implemented in 2011. The results of their analysis are presented in a table format—with estimates of the population exempt from the mandate; the population potentially affected by the mandate but already covered by insurance of some type; and the remaining population required to newly purchase coverage or pay a fine.

Many policy gurus fear that repeal of the minimum coverage provision and corresponding penalty from the Affordable Care Act (ACA) would lead to adverse selection and thus a premium spiral. However, a recent Health Affairs article highlights other ACA provisions that would mitigate the negative repercussions of an individual mandate repeal. For example, the ACA subsidies to help people purchase coverage would restrain a premium spiral by absorbing much of the impact of premium increases. The article proffers that without the individual mandate, 7.8 million people would lose coverage, as opposed to other estimates in the 16-24 million range. In sum, the ACA would still cover 23 million people who otherwise would have been uninsured. Although the individual mandate would have important effects, the article says, perhaps it is not crucial to the successful implementation of health reform.

The U.S. Government Accountability Office (GAO) has issued a report that examines ways to encourage individuals to voluntarily obtain health insurance. GAO was asked by Congress to undertake the report due to the chance "...that legislative or judicial action could result in a change to, or elimination of, the mandate..." and the report is based on multiple interviews from experts regarding alternative approaches to the individual mandate to purchase health insurance under the Affordable Care Act (ACA).