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February 17, 2015

In Defense of the Employer MandateHedging Against Uninsurance

Author Affiliations
  • 1Department of Health Policy and Management, Center for Public Health Leadership, Harvard School of Public Health, Boston, Massachusetts
  • 2Warren Alpert Medical School, Brown University, Providence, Rhode Island
JAMA. 2015;313(7):665-666. doi:10.1001/jama.2014.17658

After 2 delays, section 1513 of the Affordable Care Act (ACA)—shared responsibility for employers—is finally slated to go into effect on January 1, 2015.1 The so-called employer mandate requires large employers to offer affordable “minimum-value” health insurance to full-time employees and their dependents (to age 26 years) or be subject to annual penalties if at least 1 employee receives premium tax credits for the purchase of individual health insurance via an exchange.1 Designed to maintain employer-sponsored coverage and to offset the public cost of subsidies to eligible employees in need of health insurance, the employer mandate constitutes an important component of the ACA. However, in the wake of the recent midterm elections, this provision is likely to be singled out for repeal by the newly elected Republican-controlled Congress. In this Viewpoint, we trace the origins of the employer mandate provision, delineate its all-important rationale, and discuss the likelihood and consequences of its potential repeal.

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