The impact of the repeal of the federal individual insurance mandate on uninsurance.

The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019. However, some states implemented state-level insurance mandates which essentially replaced the federal mandate. I use nationally representative survey data from the 2015-19 Annual Social and Economic Supplement to the Current Population Survey to compare the probability of becoming newly uninsured among people living in states without state-level insurance mandates versus states with a mandate, before and after the 2019 repeal. In a sample of 214,821 lower-income, nonelderly adults, the repeal of the federal mandate was associated with a 0.5% point, or 24%, increase in the year-over-year probability of becoming newly uninsured. These results suggest that people respond to financial incentives when making insurance enrollment decisions. In the absence of a federal mandate, state-level mandates may reduce transitions to uninsurance.