Obamacare mandate takes effect; court’s move on contraception clouds milestone

**FILE** Supreme Court choice Sonia Sotomayor speaks to President Obama during an announcement on May 26, 2009, in the East Room of the White House. (Associated Press)**FILE** Supreme Court choice Sonia Sotomayor speaks to President Obama during an announcement on May 26, 2009, in the East Room of the White House. (Associated Press)
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The “individual mandate” requiring Americans to have health insurance, a giant political issue for most of President Obama’s tenure, finally takes effect Wednesday with hardly a passing notice — though the law’s contraception rules drew renewed scrutiny from a Supreme Court justice late Tuesday.

A series of delays and exemptions by the White House have watered down and pushed back key deadlines for the individual mandate. Despite its heavy campaigning for enrollment, the administration has been reluctant to brandish the threat of penalties under the Affordable Care Act for those who don’t comply.

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“You have not heard them say that at all,” said Dan Mendelson, CEO of Avalere Health, a Washington-based consultancy.

Obamacare’s authors included the annual penalty to ensure enough healthy Americans enter the market and pay premiums to offset the costs incurred by those with pre-existing conditions who no longer can be denied insurance coverage.

The mandate was the most contentious part of the law for several years and became a major issue in the 2012 Republican presidential primary campaigns.

Also in 2012, the Supreme Court ruled that the mandate was a tax and therefore constitutional.

Now, the nuts-and-bolts decisions about coverage have overtaken the philosophical conversations — at least for those rushing to sign up.

When applicants flooded the D.C. health care exchange ahead of New Year’s Day, no one said they were signing up to be in compliance with the mandate.

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“I’ve never heard that, actually,” said Mila Kofman, executive director of D.C. Health Link.

Don’t expect that to last.

As the three-month grace period begins, officials said, they will make consumers aware of the legal obligation to have health care coverage.

“We will be putting a bit more emphasis on the penalty in our messaging during the next three months, to make sure people are fully aware of it,” said Gwenda Bond, a spokeswoman for Kentucky’s state-run exchange, known as Kynect.

“That said, we have expected all along that it will take a few years for people to understand the ACA’s impact, including the mandate, and to get the uninsured population insured,” she said.

Delaying the pain

A major reason for giving little attention to the mandate this week is that the administration has imposed so many delays and exemptions as it struggles to implement the law.

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