Is there still a penalty for being uninsured?

In most states, there is no longer a penalty for being without health insurance. The ACA’s federal tax penalty for not having minimum essential coverage was eliminated after the end of 2018, under the terms of the Tax Cuts and Jobs Act of 2017. Technically, the coverage requirement is still in effect, but there’s no longer a federal penalty for non-compliance. However, some states have implemented their own health coverage requirements, with penalties for residents who don’t maintain coverage.

DC, Massachusetts, New Jersey, California, and Rhode Island have penalties for being uninsured

Although the IRS is not penalizing people who are uninsured in 2019 and beyond, states still have the option to do so. A handful of states have their own individual mandates and penalties for non-compliance:

Vermont enacted a mandate but opted not to impose any penalty for non-compliance

Vermont enacted legislation in 2018 to create a state-based individual mandate, but they scheduled it to take effect in 2020, instead of 2019, as the penalty details weren’t included in the 2018 legislation and were left instead for lawmakers to work out during the 2019 session. However, the penalty language was ultimately stripped out of the 2019 legislation (H.524) and the version that passed did not include any penalty. So although Vermont does technically have an individual mandate, there is no penalty for non-compliance (ie, essentially the same thing that applies at the federal level).

Maryland also removed penalty language from 2019 legislation

Maryland enacted HB814/SB802 in 2019. The legislation initially included an individual mandate and penalty that would have taken effect in 2021. But that portion of the bill was removed before passage, despite support from insurers and the Maryland Hospital Association, and the final version did not include any of the original mandate penalty language. Instead, the new law created an “easy enrollment health insurance program” that uses tax return data to identify people who are uninsured and interested in obtaining health coverage, and then connect them with the Maryland health insurance exchange (more details here, in the fiscal note). Since then, several additional states have created similar “easy enrollment” programs, using the state tax return to connect uninsured people with health coverage.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.