New report presents alternatives to health reform's individual mandate

Healthcare experts have proposed an array of alternatives to the reform law's individual mandate in case it gets repealed or struck down by the Supreme Court. 

A new Government Accountability Office (GAO) report outlines some of the most prevalent ideas. The report was requested last year by Sen. Ben Nelson (D-Neb.), a centrist Democrat who has shown an interest in finding a way around the unpopular mandate while retaining the law's insurance reforms, such as the requirement that health plans cover everyone regardless of pre-existing conditions. 

"Without the individual mandate or a successful alternative, the number of uninsured is certain to grow and Nebraskans, as well as all Americans, will pay a hidden tax for their health care of $57 billion each year," Nelson said in a statement. "Washington can consider the GAO's findings to ensure that everyone pay their fair share, to ban pre-existing conditions and to increase coverage. And Washington needs to explore the GAO report's alternatives and others to see if there is a successful way to improve health reform."

The GAO interviewed 41 officials from 21 organizations with different opinions about the mandate. The report makes it clear that the GAO did not endorse any of the alternatives, nor did it evaluate their effectiveness or legality. The nine alternatives that came up most frequently are: 

• Modify open enrollment periods and impose late enrollment penalties, including increased costs and/or reduced benefits; 

• Facilitate auto-enrollment for employer-sponsored healthcare;

• Conduct a public education and outreach campaign;

• Provide broad access to personalized assistance for health coverage enrollment, for example by creating access points such as pharmacies, schools and grocery stores; 

• Impose a tax to pay for uncompensated care that would apply to people without insurance or employers who don't offer it; 

• Allow greater variation in premium rates based on enrollee age - up to 5:1 instead of 3:1 under healthcare reform - to get more young, healthy people to sign up; 

• Restrict federal benefits such as college loans to people who have insurance; 

• Use health insurance agents and brokers differently, by paying them a flat fee, for example, instead of commissions that incentivize them to sell expensive coverage; 

• Require or encourage credit-rating agencies to reward people who have insurance and penalize those who don't.