New York’s health marketplace is one of the more stable in the country, but health care officials are concerned that a repeal of the requirement all Americans purchase insurance will lead to problems.

“Providers want to have as many people covered and insured as possible, because if they have insurance they are more likely to get the care that they need,” said New York State Healthcare Association Chief Operating Officer Courtney Burke.

The individual mandate is being repealed as part of the congressional tax overhaul legislation. A key piece of the Affordable Care Act, it’s meant to create a large insurance pool. Those who don’t buy plans have to pay a penalty.

“It’s a motivator for them to want to buy insurance, and with insurance you want as many people in the marketplace as possible to spread the risk around so that if someone gets the cost of care is spread among everybody,” Burke said.

But others question whether the mandate was effective. The fine for not having insurance is $695 or 2.5 percent of a person’s income. Bill Hammond of the Empire Center notes that for a healthy person, paying for insurance is much more expensive. Meanwhile, there are still incentives to buy insurance.

“All the carrots are still in place. Those are basically subsidies you get to buy insurance if your income is low enough. New York has the essential plan, which is basically free or $20 a month,” Hammond said.

New York could also introduce its own individual mandate for insurance.

“Eliminating the individual mandate — particularly if Congress fails to act on other measures aimed at stabilizing the insurance market — could trigger a deterioration of the risk pool, significant premium increases down the road and a possible return of the ‘death spiral’ of New York’s individual market.

“While it may be too early to know the extent to which the repeal of the mandate would increase premiums for 2019, it is not too early to plan for that possibility,” said Leslie Moran, the senior vice president at the New York Health Plan Association.

“With the individual mandate repeal included in the federal tax reform package, Governor Cuomo and New York lawmakers must start now to consider strategies that will ensure a strong and stable marketplace in our state.”

But having a state-level mandate in place is also a politically tricky proposal.

“We know that it’s possible for a state to do it. Whether it’s politically possible is another question. The reason why the Congress was quick to repeal this and nothing else in the ACA is because it’s the most unpopular provision,” said Hammond.

Still, repealing the insurance mandate and no other provision of the ACA, also known as Obamacare, could have a ripple effect.

“Taking one piece of what’s now a stable insurance market and starting to unravel it really affects all of the ,” said Burke.

Hammond agrees, noting the measure is losing one leg of a three-legged stool designed to boost coverage, but notes the law still has its defects.

“It’s not ideal,” he said. But on the other hand the existing law wasn’t ideal either.”

The state’s uninsured rate is at 4.7 percent, down from 10 percent only four years ago.