What We're Reading: Pulling the Wool Off the Individual Mandate

How promoting the penalties of the individual mandates changes the sign-up mix, changing attitudes on women's pelvic health, and the challenges that await Louisiana's new governor as he plans to expand Medicaid.

Sarah Kliff of Vox writes that the piece of Obamacare people like the least—the individual mandate—is starting to work. And what’s making it work is the fact that people started to talk about it; specifically, that if you didn’t sign up for healthcare, you would have to pay a fine. Talking about the penalty was important this fall, because it rises to $695 in 2016, and failure to do so would only set up problems heading into the next presidential election. As a result, a larger share of young adults—exactly the kind of folks needed to make the Affordable Care Act work—have been signing up for insurance this fall. Enrollment numbers reported by Vox show that 980,000 people under 35 had signed up so far, a big jump from 670,000 at this point last year.

A story in the Chicago Tribune brings the little-discussed issue of women’s pelvic health to light. In Europe, much more is done after a vaginal delivery to restore pelvic muscles and prevent incontinence, while in the United States, women just “live with it.” This attitude promotes a sedentary lifestyle that allows weight gain and poor cardiovascular health. Fortunately, times are changing, with new surgical options and other techniques. The founder of the Women’s Health Foundation reported there had been a “sea change” starting this year in the approach to this issue.

Louisiana’s incoming governor, John Bel Edwards, has said Medicaid expansion will be a top priority. But things will be easier said than done, according to a recently analysis by The Times-Picayune of New Orleans. The cupboard is bare at the state’s Department of Health and Hospitals after years of cutbacks under Governor Bobby Jindal, so first Edwards will have to find enough staff to handle the influx. There’s the question of how Louisiana will pay for its 10% match, which isn’t as clear cut as it seemed a few months ago. Finally, Jindal famously privatized Louisiana’s one-of-kind charity hospital system, and no one is sure how the finances of the privatization deals will work if Medicaid patients flow away from the former charity institutions, especially the state teaching hospitals in New Orleans and Shreveport.