Individual mandate would spread risk but could prove difficult to enforce

"If health care reform occurs, it is likely to include an individual mandate — a requirement that every American have health insurance," The Kansas City Star reports. "In theory, health coverage would work something like the requirement that drivers buy auto insurance. But everyone knows someone who has been hit by an uninsured, and sometimes even an unlicensed, driver." Although such a mandate could be difficult to enforce, it "appears to be the best way to ensure coverage for the most people." All three major proposals currently under discussion on Capitol Hill would require anyone to purchase a minimal level of insurance if they aren't covered through their employer or eligible for a government health insurance program. "The individual mandate would be accompanied by public subsidies for those who couldn't afford the price of health insurance, whether on the open market, through an insurance exchange or from a government option."

"To achieve universal coverage, an individual mandate is necessary to spread the risk pool, insurance companies say. It is considered the only way to insure that young, healthy people buy in and that people don't game the system by opting in and out as their health needs occur." In order to enforce the mandate, "[l]egislative proposals call for penalizing individuals who don't buy health insurance by fining them. Suggested penalties would take the form of an income tax penalty, either as a flat fee or a percentage of individuals' adjusted gross incomes" (Stafford, 9/1).