Most people will never notice the mandate, as they get insurance through their employer and that's good enough for the government. But of those who aren't exempt and aren't insured, the choice will be this: Purchase insurance or pay a small fine. In 2016, the first year the fine is fully in place, it will be $695 a year or 2.5 percent of income, whichever is higher. That makes the mandate progressive.
And what happens if you don't buy insurance and you don't pay the penalty? Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don't pay the fine. If this actually leads to a world in which large numbers of people don't buy insurance and tell the IRS to stuff it, you could see that change. But for now, the penalties are low and the enforcement is non-existent.
The theory behind the mandate is simple: It's there to protect against an insurance death spiral. Now that insurers can't discriminate based on preexisting conditions, it would be entirely possible for people to forgo insurance until, well, they develop a medical condition. In that world, the bulk of the people buying insurance on the exchanges are sick, and that makes the average premiums terrifically expensive. The mandate is there to bring healthy people into the pool, which keeps average costs down and also ensures that people aren't riding free on the system by letting society pay when they get hit by a bus.
The irony of the mandate is that it's been presented as a terribly onerous tax on decent, hardworking people who don't want to purchase insurance. In reality, it's the best deal in the bill: A cynical consumer would be smart to pay the modest penalty rather than pay thousands of dollars a year for insurance. In the current system, that's a bad idea because insurers won't let them buy insurance if they get sick later. In the reformed system, there's no consequence for that behavior. You could pay the penalty for five years and then buy insurance the day you felt a lump.
Luckily, consumers aren't usually that cynical, and the experience of places such as Massachusetts suggests that individual mandates encourage people to buy insurance even when it might make sense for people to simply pay the penalty. But for all the furor over the individual mandate, the danger in the bill is much more that it is too weak and too good a deal than that it is too strong and too punitive a tax.
Washington Post
"Eighty percent of Republicans are just Democrats that don't know what's going on"
Robert F. Kennedy Jr.
