In a new “Viewpoint” article in <em>JAMA</em>, Dr. Eli Adashi and a Harvard colleague argue that the Affordable Care Act requires employers to provide health insurance for good reasons. The authors caution against the likely alternatives if the mandate, which takes effect Jan. 1, 2015, were to be repealed.

PROVIDENCE, R.I. [Brown University] — With some employers eager to drop health insurance for employees and a newly Republican-controlled Congress threatening to dismantle Obamacare, there is a great deal of political tension as the Affordable Care Act’s “employer mandate” kicks in Jan. 1, 2015, for companies with 100 or more employees. A new “Viewpoint” article in JAMA seeks to remind readers of why the law penalizes companies that don’t insure employees.

“The core value underlying the shared responsibility principle is the realization that all of the major stakeholders of the health care system must contribute something if comprehensive healthcare is to be accomplished,” wrote Dr. Eli Adashi, former dean of medicine and biological sciences at Brown University, and John McDonough, a professor in the Harvard School of Public Health. “Without some form of shared responsibility, an important principle of health reform will be abandoned.”

Or, they noted, perhaps a million workers will lose employer-sponsored coverage.

Under the law, employers who don’t provide a minimum degree of insurance face fines meant to offset the public cost of subsidized alternatives. If the employer mandate were removed from the Affordable Care Act, Congress would need to find $151 billion over the next 10 years, according to the Congressional Budget Office, wrote Adashi and McDonough. That would make it more difficult to accomplish other health care priorities, such as repealing the “Sustainable Growth Rate” law that would slash Medicare payments to doctors by more than 20 percent, unless Congress finds $144 billion.

“The employer mandate provision has a meaningful role to play in preserving employer-sponsored health insurance,” the authors wrote. As such, they say, it is worth preserving.