Capitol Alert

Gavin Newsom’s health plan could help lower your insurance costs – or make you pay a fine

California’s new governor wants to reinstate the individual mandate at the state level. It’s part of a sweeping health care plan Gov. Gavin Newsom unveiled just hours after being sworn into office Monday. Here’s a breakdown of what the individual mandate is, what Newsom’s proposal means and how it might affect Californians.

What is the individual mandate?

The individual mandate is a fine on people who don’t have insurance. It’s part of the federal Affordable Care Act, also known as “Obamacare,” which created federal and state marketplaces where people can buy subsidized insurance.

The mandate ends this year after the federal government acted in 2017 to roll it back. Republicans in Congress and President Donald Trump argued it was unfair to penalize people for choosing not to have insurance.

Insurance markets rely on healthy people buying coverage to offset losses from people who require expensive care. The individual mandate penalty was intended to encourage people to buy insurance.

California’s uninsured rate dropped dramatically under the Affordable Care Act. But researchers at UC Berkeley and UCLA project that the federal government’s roll back of the individual mandate will cause California’s uninsured rate to rise again.

The researchers estimate that in 2020 as many as 450,000 more Californians will be uninsured than if the federal government had left the individual mandate in place.

Will Newsom’s plan lower my insurance costs?

Newsom wants to reinstate the individual mandate at the state level to bolster the Affordable Care Act and fund insurance subsidies for middle-income families.

Revenue from the penalty would subsidize health insurance for individuals earning up to $72,840 annually and families of four earning up to $150,600.

Can California do that?

Other states already have their own individual mandates. Massachusetts had one before the Affordable Care Act passed. New Jersey and Vermont have also created individual mandates.

Generally, taxes require approval by two-thirds of the California Legislature. But because the individual mandate is a “penalty,” it requires only majority approval, Newsom spokesman Nathan Click said.

If California reinstates the individual mandate, will I be fined?

Because the individual mandate was already in place until this year, Californians likely won’t experience a change if the state reimposes it. If you’re not being fined for lacking insurance now, you likely wouldn’t be fined under a state-level mandate.

Under the Affordable Care Act, people who would have to spend more than 8 percent of their income to buy insurance don’t have to pay the penalty. Native Americans, incarcerated people, undocumented immigrants and people with religious exceptions are also exempt.

California would likely keep those exceptions in place if it reinstates the individual mandate.

What else is Newsom doing on health care?

The individual mandate proposal is just one part of Newsom’s sweeping health care plans announced Monday:

- He signed an executive order to consolidate the state’s drug price negotiations by 2021. It’s intended to give California better leverage to negotiate lower costs.

- He proposed expanding the state’s Medicaid program to people living in the country illegally up to age 26. Currently, children can qualify regardless of immigration status, but people without legal status stop being eligible at 19.

- He also signed an executive order creating a California surgeon general.

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