Starting in 2014, health insurance will be mandatory and those who do not purchase insurance (but could afford to do so) will be fined by the federal government. The fine is $95 in 2014 and is $350 in 2015. Beginning in 2016 and continuing for every subsequent year, the fine will be $750 multiplied by a cost of living adjustment for the calendar year, rounded to the next lowest multiple of 50.
Appeals courts have made conflicting decisions on the constitutionality of the Patient Protection and Affordable Care Act (PPACA). On June 29, 2011, the 6th Circuit appeals court ruled that the individual mandate of the PPACA was constitutional. On Aug. 12, 2011, the 11th Circuit appeals court ruled that the individual mandate violated the constitution.
Although not directly about health care, the Militia Act of 1792(2 MB) also instituted a national mandate. It required every "free able-bodied white male citizen... who is and shall be of the age of eighteen years, and under the age of forty-five years… to provide himself with a good musket or firelock..."
As of Sep. 23, 2010, all new private health plans are required to cover, at no charge, immunizations, preventive care for infants, children and adolescents, and additional preventive care and screenings for women.
Only one Republican House Representative, Anh Cao (R-LA), voted for the House's original health care reform bill (H.R. 3962(3MB) ) in Nov. 2009. No Republican in the House or Senate, including Anh Cao, voted in favor of the two subsequent health reform bills passed by Congress (H.R. 3590(2MB) , H.R. 4872(283KB) ).
The Wall Street Journal stated in a Nov. 1, 2009 editorial that the health reform bill "may well be the worst piece of post-New Deal legislation ever introduced."
While most individuals will be required by law to purchase health insurance, The Patient Protection and Affordable Care Act(2MB) states that no individual, company, business, nonprofit organization, or health insurance company will be required to participate in any federal health insurance plan.
The new health care laws restrict insurance companies' profits by requiring them to spend at least 85% of premium dollars on medical claims for large group policy holders and 80% of premium dollars for small group policy holders. If an insurance company does not meet the established benchmarks, the additional revenue will be returned to each enrollee annually on a pro rata basis.