Monday, March 29, 2010

Does the healthcare reform increase the cost burden on the young?

Years, many of them, ago, when I was a graduate student, the university required that we international students have health insurance.  There were a couple of insurance companies we could purchase it from and one semester I got by without purchasing any insurance.  I thought I had saved that much money because, well, I was after all too young to waste money on health insurance!

So, the next semester comes around, and this time the university had become wiser--I guess I was not the only one who had skipped buying insurance.  We were informed that if we did not provide proof of insurance, the university would automatically enroll us in an insurance program and bill us for it.  I decided that it was worth testing it and didn't buy any insurance.  Bad move! Turned out that the university was serious after all, and its program was almost twice the cheapo insurance I could have purchased.

My point here is that the young, for the most part, will roll the dice because they fully know that on an average their healthcare expenses will be far, far lower than that of oldies like me.  So, does it mean then that mandating healthcare will essentially make it less expensive for the oder adults and a lot more expensive for the younger ones?

Here is one answer:
Consider 24-year-old Nils Higdon. The self-employed percussionist and part-time teacher in Chicago pays $140 each month for health insurance. But he's healthy and so far hasn't needed it.

The law relies on Higdon and other young adults to shoulder more of the financial load in new health insurance risk pools. So under the new system, Higdon could expect to pay $300 to $500 a year more. Depending on his income, he might also qualify for tax credits.
At issue is the insurance industry's practice of charging more for older customers, who are the costliest to insure. The new law restricts how much insurers can raise premium costs based on age alone. 
Insurers typically charge six or seven times as much to older customers as to younger ones in states with no restrictions. The new law limits the ratio to 3-to-1, meaning a 50-year-old could be charged only three times as much as a 20-year-old.
The rest will be shouldered by young people in the form of higher premiums.
 Meanwhile, Megan McArdle has started doing research on the implementation of the insurance mandate, and writes:
Big Government has written a post suggesting that the individual health care mandate will not actually be enforced by the IRS.  It will be assessed, but if you refuse to pay it, the normal enforcement mechanisms under Subtitle F of the tax code--such as liens and garnishments--may not be employed.
Politically, this is obviously the safest route; you don't want articles about the nice middle aged lady who may lose her house because she didn't pay her mandate.  But practically, this is disastrous, if true.  It would mean that in practice the mandate would only apply to people who get tax refunds; otherwise, just write the IRS a check for everything except the mandate.  And since you don't have to get a tax refund--you can have your employer change your withholding--anyone who doesn't want to pay it, wouldn't have to.

But it's not clear that this is what's actually going to happen.  If the IRS can reorder the priority of the tax dollars they take from you, then they can simply put any funds towards the mandate first.  That way, if you attempt to go without insurance and then pay the IRS everything except the mandate penalty, you'll end up with a tax liability the exact size of the mandate penalty . . . for which they can now garnish your wages, put tax liens on your house, and otherwise do all the nasty stuff that they are authorized to do under Subtitle F.

But if they can't do this, then the mandate is toothless.  I'd expect people will pay it in the beginning, and then over time, as it becomes public knowledge that the mandate is unenforceable, more and more people will refuse.
The Economist has a great graphic :)

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