Following a November request by Sen. Ben Nelson (D-NE), on February 25, the U.S. Government Accountability Office (GAO) released a report examining alternatives to the national health care reform law’s individual insurance mandate.  The report presents the alternatives as potential options for the federal government in the event that the insurance mandate is repealed or rejected; however, the GAO’s report does not endorse any of the measures or evaluate their effectiveness.  The report highlights automatic enrollment in employer-sponsored health plans, modifications to open enrollment periods, and the imposition of late enrollment penalties.  The report notes that other options for replacing the mandate include a public outreach campaign, improving access to health coverage purchasing assistance, taxing uncompensated care, and allowing greater variation in coverage rates to entice young individuals to enroll.  Finally, the report offers additional alternatives, including barring federal benefits to uninsured individuals, changing insurance broker compensation, and requiring or encouraging credit rating agencies to favor the insured.

From the report: 

PPACA contains a number of provisions that are designed to expand access to private health insurance, many of which take effect in 2014. For example, in addition to the individual mandate, PPACA requires the establishment of American Health Benefit Exchanges in each state by January 1, 2014, through which eligible individuals and small employers can compare and select insurance coverage amongst participating health plans.13 Upon enrolling in plans offered through the Exchanges, certain individuals may qualify for premium tax credits and cost sharing reductions.  PPACA requires the Exchanges to perform several functions, including: awarding grants to third parties to facilitate enrollment into available plans, establishing telephone hotlines to respond to requests for assistance, and maintaining Web sites to provide comparative information on health plans for consumers.  In addition, the Exchanges must provide for initial open enrollment periods, followed by annual open enrollment periods in subsequent years, as defined by the Secretary of Health and Human Services.

Full report: Private Health Insurance Coverage: Expert Views on Approaches to Encourage Voluntary Enrollment (PDF | 312.92KB)

Government Accountability Office.  (2011).  Private health insurance coverage: expert views on approaches to encourage voluntary enrollment.