One year after the historic passage of the Affordable Care Act (ACA), the individual mandate is subject to ongoing scrutiny both by the federal courts and Congress. This provision of the ACA would require most individuals to purchase health insurance, and recent attention has focused on the important legal issues associated with such a mandate. However, far less attention has been devoted to the potential effects of the mandate on the quality and cost of care and what that would mean—in real terms—for US families and their physicians. The individual mandate is integral to the health reform legislation for at least 3 reasons. First, and critically for physicians, it strengthens the patient-physician relationship. Second, it generally stabilizes insurance premiums, increases access to health insurance coverage, and provides security against significant medical expenses. Third, it addresses the pernicious “free rider” problem that is unique to US health care because of the long dysfunctional health insurance market.
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