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Comment by triangleman | Hacker News Reader

>According to White House background, provided to me after he left, they met to discuss how to get more 18-34 year-olds to sign up for the coverage under the Affordable Care Act. (The law depends on 18-34 year-olds signing up for healthcare.)

Doesn't the law _compel_ 18-34 year-olds to sign up for health insurance?

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No, it requires them to pay a fine if they don't have health insurance (see https://www.healthcare.gov/what-if-someone-doesnt-have-healt...).

The amount of the fine is fairly modest compared to the cost of most health insurance plans, though, so the worry is that 18-34s will choose to just pay the fine instead of joining the insurance risk pool.

Not a fine of course, but a "tax". A fine would be unconstitutional. My state rejected expanded medicaid, which leaves anyone in that gap between ~$2k and ~$11k with the option of paying the penalty tax or just stop working. There's a lot of the 18-30 year olds in that income bracket here.

There are a whole host of exemptions from the tax, including:

"You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act."

https://www.healthcare.gov/exemptions/

Thanks for that! I was unaware of that exemption, apparently that was added in Jun 13. It doesn't seem to be a widely published exemption.

You're welcome! I have friends in college who would've qualified for expanded Medicaid but my state didn't expand either. They were talking about this exemption which is how I learned of it.

The ACA does mandate insurance, but the point here is that the law depends on healthy 18-34-year-olds signing up on the new public exchanges such as Healthcare.gov and state-by-state sites. Right now a higher-than-expected percentage of people using Healthcare.gov are elderly or chronically ill people who had difficulty getting private insurance. If the insurance pool is full of people using the insurance, the premiums will go up, the insurance will be considered expensive, and fewer healthy people will choose public insurance, kicking off a vicious cycle.

> fewer healthy people will choose public insurance

The ACA doesn't include "public insurance" as an option. The insurance available through the exchanges is private insurance.

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