The New York Times has an article discussing the challenges associated with making health insurance mandatory, as is being done in Massachusetts:
But [Massachusetts] is discovering that making health insurance mandatory is easier said than done. It has spent the past year dealing with questions about how much basic coverage people need, and how much they can be expected to pay. (The poorest residents receive free or subsidized coverage.)[...]
[F]orcing people to buy coverage can be difficult, especially when some people do not think they need it. Almost half of the roughly 400,000 uninsured people in Massachusetts are single males, and many young men think “health insurance is for sissies,” Mr. Kingsdale said. Because young males are generally healthy, adding them to the pool of insured would most likely reduce the average cost of coverage over all, given that this particular group is not liable to need expensive treatment.
It remains uncertain whether Massachusetts can continue to find the money to pay for free or subsidized coverage, and insurers are also waiting to see whether they can afford the low premiums they are offering. States with more uninsured residents and fewer resources might have trouble finding the money for a similar plan.
The article mentions that efforts to manage the affordability concerns mean that as many as 20% of the state’s uninsured will be exempted from the requirement to buy coverage.
Not mentioned, however, is what happens in coming years as inflations in the costs of medical care applies pressure to the affordability of the scheme. Even if reducing the ranks of the uninsured actually reduces the overall cost of the system, this would be a one-time reduction. I haven’t heard anything being done to alleviate inflationary pressures…and that could grow to be a problem in a couple of years, especially if there’s a slowdown in the Massachusetts economy.