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Health Insurance Reform Mythbuster - The Shared Responsibility Requirement

Health insurance reform opponents are claiming that the shared responsibility requirement in the legislation that those who can afford health insurance have it - and that those who can afford insurance but for some reason refuse to purchase it (thereby passing their health care costs onto taxpayers) pay a modest fee - is unfair and burdensome.

As a result, according to House Republican Leader John Boehner, certain state legislators in 26 states have decided that they should protect their residents from this “unfair” requirement and “have, or will, introduce” legislation to “outlaw any mandate that individuals must pay a new tax if they don't have government-approved health insurance.”

The “rebel” lawmakers are in the minority.  Almost 1,000 state legislators from all 50 states have signed a letter in support of “bold and comprehensive health care reform this year,” including “ensuring shared responsibility among employers, individuals and government in financing health care.”

MYTH Requiring shared responsibility for health coverage places an unfair burden on individuals and families.

FACT: The shared responsibility requirement in the health reform legislation is designed to be fair to all Americans.

Under the House health reform bill, the shared responsibility requirement is:  for those who don't already have health insurance and can afford it, to either purchase insurance or pay a shared responsibility fee of 2.5 percent of their income (a fee designed to cover their costs when they use the health care system - rather than passing those costs along to taxpayers.)

First, the vast majority of Americans already have health insurance and therefore would not be affected by this requirement.  Indeed, more than 85 percent of Americans currently have insurance - employer-provided, Medicare, Medicaid, TRICARE, VA, etc. 

Secondly, the bill is designed to ensure that the shared responsibility requirement is never imposed on those who cannot afford to purchase health insurance.  Some of the key provisions are:

  • There are generous affordability credits to help people purchase health insurance on the Health Insurance Exchange - with the credits on a sliding scale according to someone's income.
  • There is a hardship exemption for those who cannot afford insurance even with affordability credits.
  • The lowest-income Americans will actually qualify for Medicaid. 

MYTHStates should “rebel” against federal reform efforts--and have the power to do so.

FACT:  House Republican Leader Boehner has endorsed the antics of the Republican state lawmakers who are introducing bills that plainly violate the Supremacy Clause of the Constitution.  If Congress does enact an individual mandate - in the form of a fee on persons who can afford to buy health insurance but refuse to do so [and thus put taxpayers at risk] -- no state law can override that mandate.

In fact, it is the requirement for all who can afford insurance to have it that makes the math work for insurance premiums to come down and coverage to improve.  House Republicans have not offered a proposal that meets those goals--and their proposed reform leaves 51 million Americans uninsured in 2019.