Health Insurance Individual Mandate Costing Massachusetts Residents More Than $35 Million Per Year

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If you don’t have health insurance in Massachusetts, in theory you must pay a fine.

In recent years, tens of thousands of Bay Staters have been paying that fine instead of purchasing health insurance — and the fine costs state residents more than $35 million per year, according to data obtained by NewBostonPost.

The Massachusetts Department of Revenue provided NewBostonPost with its data on the so-called individual mandate for health insurance for fiscal years 2019, 2020, and 2021, the three most recent years available.

The numbers show that in fiscal year 2019, 65,272 Bay Staters paid $39,503,450 in penalties to the state for not having health insurance. In fiscal year 2020, that figure took a slight dip; 57,647 paid a combined $37,469,254. And in fiscal year 2021, 51,104 Bay Staters paid a combined $36,839,836 in individual mandate penalties.

The state Department of Revenue did not have data available for fiscal year 2022.

Massachusetts has had an individual health insurance mandate in place since 2007.

Chapter 58 of the Acts of 2006, signed into law by then-Governor Mitt Romney, gave Massachusetts its health insurance individual mandate. Many call the bill Romneycare, given its similarities to The Affordable Care Act, a federal bill commonly referred to as Obamacare.

Under the state law, most Massachusetts residents who are 18 years old or older must obtain health insurance or pay a fine.

To meet state standards, a health insurance plan must cover four main services:  physician services, in-patient acute care, day surgery, and diagnostic procedures and tests.

More specifically, the plan must cover the following services, as the consulting firm Mercer points out:


  • Ambulatory patient services, including outpatient, day surgery, and related anesthesia

  • Diagnostic imaging and screening procedures, including X-rays

  • Emergency services

  • Hospitalization, including — at a minimum — inpatient services typically provided at an acute care hospital

  • Maternity and newborn care, including prenatal care, post-natal care, and delivery and inpatient maternity services

  • Medical/surgical care, including preventive and primary care

  • Mental health and substance abuse services

  • Prescription drugs

  • Radiation therapy and chemotherapy


The individual mandate penalty varies depending on one’s income level. If someone earns between 150.1 percent and 200 percent of the federal poverty level ($12,880), that person pays $23 per month ($276 per year) in penalties. If someone earns between 200.1 percent and 250 percent of the federal poverty level, that person pays $45 per month ($540 per year). Meanwhile, if someone earns 250.1 percent to 300 percent of the FPL, that person pays $67 per month ($804 per year). And if someone earns more than 300 percent of the federal poverty level, they pay $159 per month ($1,908 per year).

The federal poverty level fluctuates. The calculation is based in part on family size.

Other major provisions of Romneycare include requiring companies with 11 or more employees to provide their employees with health insurance, providing government subsidies for health insurance coverage to families earning between 150.1 percent to 300 percent of the federal poverty level, and establishing the Massachusetts Health Connector — a web site that allows people to see all of their insurance coverage options.

Supporters of the individual mandate argue it is vital for people to have health insurance, that penalizing people for not having health insurance will incentivize more people to purchase it, and that getting more young and healthy people to buy into the health insurance system lowers costs for everyone else.

Romney, who served as governor of the state from 2003 to 2007, ran for president in 2008 and 2012, and now serves as a U.S. senator from Utah, has also argued that the law embodies what he calls “personal responsibility” by requiring people to have health insurance.

“I will repeal ObamaCare, but the Massachusetts plan was right for Massachusetts,” Romney said during an August 2011 event while running for president the second time. “Personal responsibility was the way to go. People in Massachusetts favor the plan 3 to 1. If they don’t like it they can get rid of it. I like what we did in our state. It won’t work in Mississippi. That’s what’s great about a state plan. Obama is trying to impose on nation. I like personal responsibility and I like freedom.”

Opponents argue that the mandate is a regressive tax on people for the pleasure of not having health insurance; some also argue that the government should now have the power to force people to purchase a product. 

A spokesman for the Massachusetts Department of Revenue could not be reached for further comment on the issue on Tuesday, Wednesday, or Thursday this week. 


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