What if the government pushed the impact date back one year? (NASA image)

Pushing the individual health insurance mandate back one year would cause “major disruption” to the Patient Protection and Affordable Care Act’s implementation and result in decreased coverage and increased premiums for consumers.

That’s the case Linda Blumberg and John Holahan, two analysts who support the goals of PPACA, made in a commentary released by the Urban Institute.

The Internal Revenue Service already has delayed by one extra year to begin enforcing a PPACA requirement that large employers provide health benefits or else pay a penalty.

The IRS and other federal agencies often put off enforcement of other big, complicated federal requirements a year or two past the date in the statute.

Why not the PPACA requirement that individuals own a minimum level of health coverage or else pay a penalty?

Blumberg and Holahan argue that the individual mandate is different from the employer mandate.

“Unlike delaying the employer mandate, postponing the individual mandate would start a domino effect with consequences ranging from millions more people without insurance to those who do purchase insurance having to pay much higher prices,” Blumberg said. “The disruptions and pressures that would be created by a delay could lead us back to square one with people being denied coverage based on what conditions they have and plans not covering all the necessary services.”

Most of the employers that would be affected by the employer mandate already offer group health benefits, and delaying their mandate would probably have a small effect on the number of people with group health coverage, the analysts said.

In the individual market, PPACA designers tried to make up for the cost of requiring insurers to sell coverage on a guaranteed-issue, mostly community-rated basis by using a coverage mandate to increase the number of healthy people with health coverage.

Pushing back the effective date of the individual mandate could cut the number of healthy people with health coverage enough to throw off insurer pricing models, the analysts said.

Insurer claims costs and hospital uncompensated care costs could soar, and “this reduced stability could lead to political pressure for changes in consumer protections,” the analysts said.

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