<P> The Affordable Care Act of 2010 was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created health insurance exchanges . This requirement for almost all individuals to maintain health insurance is often referred to as the "individual mandate ." The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive coverage because of the act by 2022 . </P> <P> Repeal of the Individual Mandate </P> <P> The Tax Cuts and Jobs Act of 2017 effectively repealed the individual mandate, meaning that individuals will no longer be penalized for failing to maintain health coverage starting in 2019 . The CBO projects that this change will result in four million more uninsured by 2019, 13 million more by 2027 . </P> <P> Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts . This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents . Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter . While there were earlier experiments, sickness coverage in the US effectively dates from 1890 . The first employer - sponsored group disability policy was issued in 1911, but this plan's primary purpose was replacing wages lost because the worker was unable to work, not medical expenses . </P>

Does everyone in the us have to have health insurance