The ACA requires health insurers in the individual and group markets to provide coverage on a “guarantee issue” basis without any pre-existing condition exclusions—which could create an environment where individuals wait until they are sick to obtain coverage absent strong incentives to assure that everyone participates in the marketplace. States that have enacted similar approaches have seen significant premium increases, less competition and a loss of consumer choice. To counter-balance some of the effects of this and other insurance market reforms, the ACA also includes a requirement that all Americans carry basic health insurance. Yet many experts question whether the coverage requirement will be sufficient to encourage younger and healthier people to take up coverage. In fact, the penalty for failing to carry insurance in 2014 will be as low as $95.