Republicans in Congress and the Trump administration repealed the penalties associated with the Affordable Care Act's individual mandate in the tax act that passed in December. Now they need to replace the mandate with something that will address rising premiums and command broader support. Automatic enrollment into health insurance plans is a good place to start.
A replacement for the mandate is needed because the A.C.A.'s insurance rules are still in place. Those rules, which enjoy bipartisan support, protect the sick by requiring insurers to charge the same premiums to all consumers of the same age without consideration of their health status. The mandate was supposed to encourage the healthy to stay continuously insured, through a federal tax assessment for every month without coverage, even though they could drop coverage and later acquire it when needed, without paying higher premiums. With enforcement of the mandate ending in 2019, more healthy people may leave the A.C.A.'s exchanges, driving up premiums even faster for those who remain in the market.
