By NextBestFitIndividual mandate with larger subsidies
Require everyone to buy coverage, with a penalty for not doing so, and raise ACA subsidies so it is affordable.
Draft decision:RejectedConfidence: high · not yet reviewed
Conflicts with single payer; penalties fall on low-income people.
Review ledgerHow this path connects
This path
Individual mandate with larger subsidies
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Restore an individual mandate penalty collected on tax returns
- Raise ACA premium subsidies permanently and extend them to all incomes with a cap as a percentage of income
- Exempt low-income households from penalties
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Tens of millions of people have no coverage
Requiring coverage and increasing affordability subsidies uses a familiar structure while keeping private insurance intact. Weak mandates still leave many people uninsured.
What it creates or worsens
- Directs benefits or burdens imperfectly
Mandate penalties fall on lower-income people.
- Solves only part of the problem
Retaining private insurance preserves current administrative costs.
Who's affected
Who gains
- Uninsured people
- Tens of millions of people have no coverage: They delay care, go without, or pay full price.
Who loses
- Employers
- Tens of millions of people have no coverage: Employers that don't offer coverage avoid its cost.
- Taxpayers and public budgets
- Tens of millions of people have no coverage: Public budgets avoid subsidy costs in the short run.
- Uninsured people
- Directs benefits or burdens imperfectly: Mandate penalties fall on lower-income people.
Other ways to soften the losses
- Exempt low-income people from penalties
Where it has been tried
- U.S. ACA (2014–2018): The federal mandate penalty was set to $0 in 2019; coverage fell only slightly.
- United States: The U.S. uninsured rate among people ages 0–64 rose from 10.4% in 2018 to 10.9% in 2019, when the federal mandate penalty ended.Sources: KFF (2025)
Conflicts with (choose one or the other)
Other paths for “Tens of millions of people have no coverage”
Single public payer for everyoneTens of millions of people have no coverageChosenRegulated multi-payer: everyone must have a non-profit or tightly regulated planTens of millions of people have no coverageRejectedPublic option alongside private insuranceTens of millions of people have no coverageRejectedLower the Medicare age step by step (and enroll children at birth)Tens of millions of people have no coverageRejectedAutomatic enrollment with free default coverageTens of millions of people have no coverageChosen