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March 2013


Proposed and Final Rules Released Regarding the ACA's Individual Mandate


Beginning in 2014, the Affordable Care Act's (ACA) individual mandate requires most individuals to have "minimum essential coverage" or pay a "shared responsibility payment." In upholding the individual mandate last summer, the United States Supreme Court held that the individual mandate is not a legal command to buy insurance but rather a tax. Given this, if uninsured individuals do not obtain coverage they will be forced to pay a shared responsibility payment to the IRS at the end of the tax year.

On January 30, 2013, the U.S. Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) collectively released two proposed rules and a final rule regarding the individual mandate. Most recently, HHS released an essential health benefits final rule on February 20, 2013.

In addition to providing guidance on minimum essential coverage, the January regulations explain the mandate's shared responsibility provision and lay out the eligibility rules for receiving an exemption as well as the process by which individuals can receive certificates of exemption. Both agencies' proposed regulations include rules that will ease implementation and help ensure that the payment applies only to the limited group of taxpayers who choose to spend a substantial period of time without coverage despite having access to affordable health care. According to the Congressional Budget Office (CBO) less than two percent of Americans will owe a shared responsibility payment.

Minimum Essential Coverage

  • HHS Proposed Rule

Shared Responsibility Payments and Exemptions

  • HHS Proposed Rule
  • IRS Proposed Rule
  • IRS Final Rule

Essential Health Benefits

  • HHS Final Rule

The Individual Mandate's Impact on Health Care Providers

Moving Forward

HHS and the IRS are currently seeking comments on these proposals. Comments on the Treasury Department (IRS) proposed regulations are due by May 2, 2013, and a public hearing will be held on May 29, 2013. Comments on the HHS proposed regulations are due by March 18, 2013.

  • To read the HHS proposed rule, visit here.
  • To read the IRS proposed rule, visit here.
  • To read the IRS final rule, visit here.

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