Congressional Budget Office
Payments of Penalties for Being Uninsured Under the
Affordable Care Act
September 19,
2012
Beginning in 2014, the Affordable Care Act (comprising Public Law 111-148 and
the health care provisions of P.L. 111-152) requires most legal residents
of the United States to either obtain health insurance or pay a penalty tax.
That penalty will be the greater of: a flat dollar amount per person that rises
to $695 in 2016 and is indexed by inflation thereafter (the penalty for children
will be half that amount and an overall cap will apply to family payments); or a
percentage of the householdfs income that rises to 2.5 percent for 2016 and
subsequent years (also subject to a cap).
The Congressional Budget Office (CBO) and the staff of the Joint Committee on
Taxation (JCT) have estimated that about 30 million nonelderly residents will be
uninsured in 2016, but the majority of them will not be subject to the penalty
tax. Unauthorized immigrants, for example, who are prohibited from receiving
almost all Medicaid benefits and all subsidies through the insurance exchanges,
are exempted from the mandate to obtain health insurance. Others will be subject
to the mandate but exempted from the penalty tax—for example, because they will
have income low enough that they are not required to file an income tax return,
because they are members of Indian tribes, or because the premium they would
have to pay would exceed a specified share of their income (initially 8 percent
in 2014 and indexed over time). CBO and JCT estimate that between 18 million and
19 million uninsured people in 2016 will qualify for one or more of those
exemptions. Of the remaining 11 million to 12 million uninsured people,
some individuals will be granted exemptions from the penalty because of
hardship, and others will be exempted from the requirement on the basis of their
religious beliefs.
After accounting for those who will not be subject to the penalty tax, CBO
and JCT now estimate that about 6 million people will pay a penalty because
they are uninsured in 2016 (a figure that includes uninsured dependents who have
the penalty paid on their behalf) and that total collections will be about $7
billion in 2016 and average about $8 billion per year over the 2017–2022 period.
Those estimates differ from projections that CBO and JCT made in April 2010:
About two million more uninsured people are now projected to pay the penalty
each year, and collections are now expected to be about $3 billion more per
year.
Most of the increase—about 85 percent—in the number of people who are
expected to pay the penalty tax stems from changes in CBO and JCTfs baseline
projections since April 2010, including the effects of legislation enacted since
that time, changes in the economic outlook (primarily a higher unemployment rate
and lower wages and salaries), and other technical updates. A small share—about
15 percent—of the increase in the number of uninsured people expected to pay the
penalty results from the recent Supreme Court decision. As a result of that
decision, CBO and JCT now anticipate that some states will not expand their
Medicaid programs at all or will not expand coverage to the full extent
authorized by the ACA. Such state decisions are projected to increase the number
of uninsured, a small percentage of whom will be subject to the penalty tax.
Among the uninsured individuals subject to the penalty tax, many are expected
to voluntarily report on their tax returns that they are uninsured and pay the
amount owed. However, other individuals will try to avoid payments. Therefore,
the estimates presented here account for likely compliance rates, as well as the
ability of the Internal Revenue Service (IRS) to administer and collect the
penalty.
CBO and JCT have also updated their estimates of the distribution of those
penalty tax payments by income category. Table 1 shows how much of those
payments are projected to be made by or on behalf of people who are uninsured in
2016 (which the IRS will collect in 2017) in each of several income categories,
measured as percentages of the federal poverty level (FPL). In general,
households with lower income will be subject to the flat dollar penalty (with
adjustments to account for the lower penalty for children and an overall cap on
family payments), and households with higher income will owe a percentage of
their income. In 2016, households with income that exceeds 400 percent of the
FPL are estimated to constitute about one-third of people paying penalties and
to account for about two-thirds of the receipts from those penalties.