The individual mandate is what keeps health insurance affordable under Obamacare

In need of care.
In need of care.
Image: Reuters/Kevin Lamarque
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The GOP has not been able to replace, or repeal, Obamacare, but its new tax bill contains a provision that could effectively kill the plan: The end of the individual mandate.

The individual mandate requires that US individuals and companies provide health insurance for themselves and their employees. Forcing a large number of Americans to participate in health insurance coverage is key to making Obamacare affordable for everyone.

Ending the individual mandate was part of the Senate’s failed July attempt at a “skinny repeal” of the Affordable Care Act. As Josh Bivens, research director at the Economic Policy Institute, told Quartz then, ending the mandate would create prohibitive premiums for everyone who stayed with Obamacare. Many healthy people who were uninsured before Obamacare are currently buying insurance because of the individual mandate. Since healthy people don’t claim many medical expenses, those healthy participants lower the risk for insurers, offsetting the overall cost.

But if everyone who felt fairly healthy decided they didn’t need health insurance, insurance companies would be left covering more people with medical problems and high expenses. Since insurers wouldn’t be allowed to deny coverage, they’d likely raise their premiums, which could in turn discourage even more people from getting insured.

According to a CBO estimate, canceling the individual mandate would ultimately lead to 15 million people losing health insurance over the next decade, and find those who keep their insurance paying through the nose. In contrast, a complete repeal of the Affordable Care Act would have seen 32 million Americans lose insurance, and the various proposed versions of the Republican health-care bill, an estimated 22-23 million.