Lifting the Individual Mandate: What it Means & What’s Next


Regardless of what side of the political fence you sit on, we can all agree that President Trump has taken us on quite a trip since his swearing into office. One of the most prominent things you may have heard about is the lifting, or repealing, of the individual mandate that was initiated as part of the Affordable Care Act (ACA) aka Obamacare. What even is the individual mandate, you ask? That’s a good question. Let’s talk about it.

What is the individual mandate?

The ACA initiated many different policies concerning healthcare and insurance, one of them being a requirement for all individuals to have health insurance. The reasoning behind this initiative was that previously, mostly only sick people had insurance policies (aka people who knew they’d need it) and generally healthy people often opted out. It might sound logical, but it resulted in much higher plan premiums and deductibles since insurance companies could almost guarantee most of their clients would require them to pay for something at some point.

Former president Obama attempted to solve this issue, and instated the individual mandate as part of his healthcare overhaul. The mandate required all citizens to have some kind of health insurance policy, be it from an employer, the government, or privately purchased. By requiring everyone to have insurance, (sick and healthy people alike) the number of people paying for insurance helped to balance out the number of people who would require a payout at some point. The idea was to enable health insurance companies to lower plan premiums for many people. What actually resulted was astronomically high deductibles, premiums, and some pretty hefty penalties that, in essence, punished people who made the choice to opt-out of some type of insurance coverage.

What does this mean?

Now, President Trump has passed a bill that somewhat reverses that part of the ACA (in addition to other things). So what does this mean? How does it affect people? Well that depends mostly on how you earn your living. First of all, the Marketplace that was initiated through the ACA isn’t going anywhere. So regardless of how you’re affected, the option for finding and purchasing health insurance through the Marketplace will still be available to everyone. Second, none of these changes will take place until 2019. Third, if you’re employed by a person or a company and receive benefits that include health insurance from them as part of your job, or if you get health insurance from the government (Medicare/Medicaid etc.) you won’t be affected much. However, if you do not receive healthcare insurance benefits from an employer or the government, this could mean big changes for you!

Businesses v individuals

Under the ACA’s individual mandate, since everyone was required to have health insurance, small business owners with more than 50 employees had to provide health insurance & benefits options to their employees. Now that the individual mandate will soon be lifted, that will no longer be the case. Small business owners and their employees, as well as other individuals who do not receive insurance from their employer but do not qualify for Medicaid/Medicare, will soon be able to opt out of purchasing/providing a health insurance plan once again. The repeal will undoubtedly result in a quite a surge of uninsured people.

As a matter of fact, the nonpartisan Congressional Budget Office estimates that 13 million people will be uninsured in 2027 if Trump’s new healthcare overhaul holds out until then. On one hand, this may seem like a positive thing: no longer will some be forced to pay for health insurance they know they won’t use! On the other hand, remember all of those high premiums that resulted from mostly sick people having health insurance? Many expect those to return since the balance of healthy & sick insured people will be disrupted.

On a different note, how do we know for sure when we won’t need some kind of coverage or assistance with healthcare? Regular checkups are definitely in everyone’s best interest, and even those can be super costly without insurance, not to mention car accidents, sudden health problems, and other healthcare related issues life likes to throw our way when we least expect it. Add to that the fact that getting approved for an insurance plan becomes astronomically more difficult once you’re sick and going without some kind of healthcare coverage plan is really no longer an option, especially given the out of pocket cost of most procedures & appointments.

What are your choices?

Will you be forced to revoke your employees’ benefits as they become more and more unaffordable, therefore forcing them to either go uninsured or purchase even more expensive policies on their own? Do you have any options, or are you stuck with buying an expensive insurance policy or not buying insurance at all? I have great news for you! As a small business owner, or an employee of a small business, or anyone else who doesn’t want to buy traditional insurance out of pocket, you can choose none of the above and still offer an affordable option to your employees (or yourself)!

ProHealth Medical Membership (PMM) is a benefit that you can offer to your employees or purchase individually for very reasonable rates. At $34.95/month or just over $400/year, this medical membership program is undoubtedly the most affordable healthcare plan in the area. On top of that, all members get 24/7 access to quality healthcare Providers for their ENTIRE family via Teladoc virtual care, as well as unlimited office visits at a very affordable $12 copay. PMM members will also receive 10% discounts on lab work and procedures done in the clinic, 50% off vitamin B12 shots, and a free yearly flu vaccine.

Last but not least, if a membership’s annual fee is paid in full up front, the first month is on us! So your $400/year membership fee drops to $385 instantly! That’s less than a lot of monthly premiums for traditional insurance, and it gets you a WHOLE YEAR of coverage with us! When you compare that to the healthcare plans currently offered by traditional insurance companies, and take into account the soon-to-be rising premiums, PMM might seem too good to be true. Rest assured, it’s definitely true! Just give us call or come on in and we’ll be glad to help you believe it.