In the days since the Supreme Court upheld President Obama's health care law, a debate has grown louder, particularly in the presidential campaigns, over whether the mandate in the health care overhaul is a tax. National Journal correspondent Major Garrett describes the latest.
Showing posts with label mandate. Show all posts
Showing posts with label mandate. Show all posts
Friday, July 6, 2012
Friday, June 22, 2012
Health insurers foresee rising premiums if court nixes 'individual mandate'
When President Obama pushed for a sweeping overhaul of America's health insurance system in 2010, the health insurance industry went along with a central premise of the law: that it would agree to insure "all comers," regardless of their state of health, if a new mandate also coaxed younger and healthier Americans to buy insurance.
In principle, millions of Americans who could not otherwise afford insurance would be covered, while the influx of healthy purchasers of insurance would help pay the costs. Any day now, in a ruling by the US Supreme Court, this central bargain in Mr. Obama's Affordable Care Act could unravel.
It's not hard to see why the health insurance industry doesn't like that idea. The Supreme Court could rule that the "individual mandate" in the law is unconstitutional, thus removing a big expected stream of revenue, while leaving in place the law's guaranteed-access provisions, which impose big costs on insurers.
RECOMMENDED: How much do you know about health-care reform? Take our quiz!But outside experts say the negative consequences also would ripple beyond the insurance business to affect the pocketbooks of millions of Americans, who would face a rising price for their health insurance.
"We have the worst possible outcome" in this scenario, says J.D. Kleinke, a health-policy expert at the conservative American Enterprise Institute. Yet this outcome appears quite probable, he says, because the Supreme Court is tasked with considering questions of law and the Constitution, not what would be optimal for America's health-care system.
"They're thinking about it legally.... They've got pressure not to be activist," says Mr. Kleinke. He predicts that "their tendency is going to be to do as little as possible but still do what they believe is legally correct. You do the math on that, you end up with: They take away the mandate, they leave the rest."
The court case could bring new and sharper definition to the clause of the Constitution that allows Congress to regulate interstate commerce. The central question is: Does a mandate on individuals to carry insurance (or pay a fine) represent a lawful regulation of commerce or an unconstitutional intrusion of the federal government on the affairs of individuals and state governments?
It's possible that the high court will opt for a ruling that doesn't center solely on the individual mandate. The justices could vote to uphold the entire Affordable Care Act (ACA), or they could strike it down entirely. Or they might sweep away both the individual mandate and the law's central marketplace reforms (guaranteed access to insurance) together, following the reasoning of the industry and the Obama administration that those provisions have an inherent linkage.
If the court strikes down the individual mandate without doing anything else, many Americans would still be glad to have the ACA's provision of access to insurance, without regard to preexisting health conditions.
And it's not clear how much insurance costs would rise. Some studies by health-care experts suggest the price jump could end up being smaller than the dire rhetoric from the industry implies – especially after factoring in the law's tax credits that defray the cost of buying insurance.
Other studies conclude that the rise would be substantial for families who don't have coverage through employer-sponsored plans. One midrange estimate of the impact, from the Congressional Budget Office, is that insurance premiums could go up by about 15 percent.
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Health insurers foresee rising premiums if court nixes 'individual mandate'
When President Obama pushed for a sweeping overhaul of America's health insurance system in 2010, the health insurance industry went along with a central premise of the law: that it would agree to insure "all comers," regardless of their state of health, if a new mandate also coaxed younger and healthier Americans to buy insurance.
Skip to next paragraphIn principle, millions of Americans who could not otherwise afford insurance would be covered, while the influx of healthy purchasers of insurance would help pay the costs. Any day now, in a ruling by the US Supreme Court, this central bargain in Mr. Obama's Affordable Care Act could unravel.
It's not hard to see why the health insurance industry doesn't like that idea. The Supreme Court could rule that the "individual mandate" in the law is unconstitutional, thus removing a big expected stream of revenue, while leaving in place the law's guaranteed-access provisions, which impose big costs on insurers.
But outside experts say the negative consequences also would ripple beyond the insurance business to affect the pocketbooks of millions of Americans, who would face a rising price for their health insurance.
"We have the worst possible outcome" in this scenario, says J.D. Kleinke, a health-policy expert at the conservative American Enterprise Institute. Yet this outcome appears quite probable, he says, because the Supreme Court is tasked with considering questions of law and the Constitution, not what would be optimal for America's health-care system.
"They're thinking about it legally.... They've got pressure not to be activist," says Mr. Kleinke. He predicts that "their tendency is going to be to do as little as possible but still do what they believe is legally correct. You do the math on that, you end up with: They take away the mandate, they leave the rest."
The court case could bring new and sharper definition to the clause of the Constitution that allows Congress to regulate interstate commerce. The central question is: Does a mandate on individuals to carry insurance (or pay a fine) represent a lawful regulation of commerce or an unconstitutional intrusion of the federal government on the affairs of individuals and state governments?
It's possible that the high court will opt for a ruling that doesn't center solely on the individual mandate. The justices could vote to uphold the entire Affordable Care Act (ACA), or they could strike it down entirely. Or they might sweep away both the individual mandate and the law's central marketplace reforms (guaranteed access to insurance) together, following the reasoning of the industry and the Obama administration that those provisions have an inherent linkage.
If the court strikes down the individual mandate without doing anything else, many Americans would still be glad to have the ACA's provision of access to insurance, without regard to preexisting health conditions.
And it's not clear how much insurance costs would rise. Some studies by health-care experts suggest the price jump could end up being smaller than the dire rhetoric from the industry implies – especially after factoring in the law's tax credits that defray the cost of buying insurance.
Other studies conclude that the rise would be substantial for families who don't have coverage through employer-sponsored plans. One midrange estimate of the impact, from the Congressional Budget Office, is that insurance premiums could go up by about 15 percent.
Saturday, April 14, 2012
'Stop pandering': Eliot Spitzer's advice to Romney and Gingrich on health care mandate
"Viewpoint" host Eliot Spitzer uses Herman Cain's latest anti-government ad as a launching point to discuss the health care mandate. He cites the example of Mary Brown -- who filed a lawsuit challenging the mandate -- for the $4,500 hospital bill that taxpayers footed when she went bankrupt. The mandate, Spitzer argues, "prevents freeloaders like Mary Brown from being there and just preying off the rest of us.
Tune in Weeknights at 8:00/7:00c on Current TV
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Tune in Weeknights at 8:00/7:00c on Current TV
http://current.com/shows/viewpoint/
Sunday, April 8, 2012
Can the health care reform law survive without the individual mandate?
Two health care reform protesters on the first day of oral arguments. (Charles Dharapak/AP)Could President Obama's sweeping health care reform law survive if the court strikes down the requirement that all Americans buy insurance?
The short answer is yes -- but insurance companies certainly won't be happy about it.
Both Justice Department lawyers and their challengers agree that the individual mandate is not "separable" from the rest of the law, which means the rest of the law can't survive if the individual mandate is surgically removed by the court.
[Complete coverage of the Supreme Court health care case]
The lower courts have been split on the question, but one of them, the 11th Circuit Court of Appeals, ruled in August that only the mandate should be struck down, leaving the rest of the law's provisions -- including an expansion of Medicaid to cover all low-income people and federal subsidies for lower-income and middle-class people to buy insurance -- in place.
That decision no doubt sent shivers down the spines of some insurance executives. Striking down the mandate could be a nightmare scenario for the health insurance industry, since the rest of the law compels them to accept sick customers and to not charge higher premiums based on a customer's health, age or gender. Sick customers would flood the insurance market and drive up costs, while young, healthy uninsured people would take their chances and not buy coverage, in what insurers worry would be a "death spiral" of rising costs.
[Related: Monday's audio of the Supreme Court health care law oral arguments]
The Congressional Budget Office estimated that premiums in the individual market would increase 15 to 20 percent if just the mandate is struck down, since millions of healthier Americans would could forgo buying insurance and thus not offset the costs of new sick customers. But a study by the Rand Corporation estimated a more modest premium increase of less than 3 percent. MIT Professor Jonathan Gruber wrote in an analysis for The Center for American Progress that 50 to 75 percent fewer uninsured people would be covered by 2019 under the law if there was no mandate, but that the government would only save 25 to 30 percent on the lower numbers.
Starting in 2014, the mandate will levy a penalty of 1 percent of a person's income on those who don't buy health insurance, with exceptions for religious objections and financial hardship. The fee would eventually increase to 2.5 percent of annual income or $695, whichever is higher.
Maura Carley, president of the patient advocacy firm Healthcare Navigation, tells Yahoo News that New York state provides a case study for what could happen if the mandate is struck down, but insurers are still required to take every patient and charge them equally.
"We go back to 1993," she said, referring to when the state passed a law requiring insurance companies to cover everyone. "Every New Yorker can get individual coverage, they just can't afford it." (Unlike in New York, the health care law will offer subsidies to people to purchase health insurance.)
To avoid this outcome, Justice Department attorneys are asking the court to strike down the regulation requiring insurers to take all customers if they decide to kill the individual mandate. In this, they partially agree with the 26 states that are suing the government over the law. The states' attorney, Paul Clement, will argue that the entire law needs to be struck down, echoing Florida-based Federal Judge Roger Vinson's ruling that Congress would not have passed the law without the individual mandate, and thus the entire thing should fall.
[Related: Santorum uses Supreme Court health care hearing to knock Romney]
If the Court does only strike down the mandate, the death spiral could be averted, argues Aaron E. Carroll, an associate professor at the Indiana University School of Medicine. He writes that the government could give big tax breaks to people who buy insurance as one way to prevent "adverse selection." Princeton sociologist Paul Starr writes that Congress could replace the mandate's monetary penalty with an opt-out system, where people who choose not to purchase insurance must sign a form saying they won't buy insurance for a period of five years. This would prevent some people from waiting until they get sick to buy insurance, which drives up costs.
But any of those changes would actually require Congress to pass new laws, which seems highly unlikely given that Republicans control the House and are pushing for a full repeal of the law. Individual states could take up the cause, by passing their own mandates or other measures to encourage people to buy insurance.
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Sunday, April 1, 2012
Court: What's left of health law without mandate?
WASHINGTON (AP) — The heart of the Obama administration's health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.
The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.
As the arguments resumed Wednesday morning, a small group of demonstrators gathered outside. Supporters of the law held a morning news conference where speakers talked about the importance of Medicaid. And, marching on the sidewalk outside the court, supporters repeated chants they've used the past two days including "Ho, ho, hey, hey, Obamacare is here to stay." ''Protect our care. Protect the law," supporters chanted as several played instruments including a trumpet and drum.
Opponents of the law, including Susan Clark of Santa Monica, Calif., also stood outside the court. Clark, who was wearing a three-cornered colonial-style hat, carried a sign that read "Obamacare a disaster in every way!"
"Freedom, yes. Obamacare, no," other opponents chanted.
The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress' authority to require virtually every American to carry insurance or pay a penalty.
The outcome of the case will affect nearly all Americans and the ruling, expected in June, also could play a role in the presidential election campaign. Obama and congressional Democrats pushed for the law's passage two years ago, while Republicans, including all the GOP presidential candidates, are strongly opposed.
But the topic the justices take up Wednesday only comes into play if they first find that the insurance mandate violates the Constitution. If they do, then they will have to decide if the rest of the law stands or falls.
The states and the small business group opposing the law say the insurance requirement is central to the whole undertaking and should take the rest of the law down with it.
The administration argues that the only other provisions the court should kill in the event the mandate is stricken are insurance revisions that require insurers to cover people regardless of existing medical problems and limit how much they can charge in premiums based on a person's age or health.
The federal appeals court in Atlanta that struck down the insurance requirement said the rest of the law can remain in place, a position that will be argued by a private lawyer appointed by the justices, H. Bartow Farr III.
On Tuesday, the conservative justices sharply and repeatedly questioned the validity of the insurance mandate.
If the government can force people to buy health insurance, justices wanted to know, can it require people to buy burial insurance? Cellphones? Broccoli?
Audio for Tuesday's court argument can be found at: http://apne.ws/Hft6z3.
The court focused on whether the mandate for Americans to have insurance "is a step beyond what our cases allow," in the words of Justice Anthony Kennedy.
"Purchase insurance in this case, something else in the next case," Chief Justice John Roberts said.
But Kennedy, who is often the swing vote on cases that divide the justices along ideological lines, also said he recognized the magnitude of the nation's health care problems and seemed to suggest they would require a comprehensive solution.
And Roberts also spoke about the uniqueness of health care, which almost everyone uses at some point.
"Everybody is in this market, so that makes it very different than the market for cars or the other hypotheticals that you came up with, and all they're regulating is how you pay for it," Roberts said, paraphrasing the government's argument.
Kennedy and Roberts emerged as the apparent pivotal votes in the court's decision.
The law envisions that insurers will be able to accommodate older and sicker people without facing financial ruin because the insurance requirement will provide insurance companies with more premiums from healthy people to cover the increased costs of care.
"If the government can do this, what else can it not do?" Justice Antonin Scalia asked. He and Justice Samuel Alito appeared likely to join with Justice Clarence Thomas, the only justice to ask no questions, to vote to strike down the key provision of the overhaul. The four Democratic appointees seemed ready to vote to uphold it.
Kennedy at one point said that allowing the government mandate would "change the relationship" between the government and U.S. citizens.
"Do you not have a heavy burden of justification to show authorization under the Constitution" for the individual mandate? asked Kennedy.
At another point, however, he also acknowledged the complexity of resolving the issue of paying for America's health care needs.
"I think it is true that if most questions in life are matters of degree ... the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That's my concern in the case," Kennedy said.
Justice Ruth Bader Ginsburg said she found the debate over health care similar to an earlier era's argument about the Social Security retirement system. How could Congress be able to compel younger workers to contribute to Social Security but be limited in its ability to address health care? she wondered.
"There's something very odd about that, that the government can take over the whole thing and we all say, Oh, yes, that's fine, but if the government wants to preserve private insurers, it can't do that," she said.
___
Associated Press writers Jesse J. Holland and Jessica Gresko contributed to this report.
Is the health care mandate on life support?
Editor’s note: The Supreme Court’s three days of hearings on health care end today. The audiotapes of those hearings, and the written transcripts, will be available later in the day on the Court’s own website, www.supremecourt.gov.![]()
Photo via Wikimedia Commons. Courtesy of DonkeyHotey.
The centerpiece of the new federal health care law, and its most controversial part – the individual insurance mandate – looked to be doomed after the first hour of the Supreme Court’s hearing on it Tuesday. But it seemed to rally in the second hour, and, while not exactly assured of being upheld, had conspicuous signs of new life.
When the Court’s most conservative Justices started the hearing with a barrage of very hard questions for the government’s lawyer, Solicitor General Donald B. Verrilli, Jr., those in the courtroom started focusing on Justice Anthony M. Kennedy, to see whether he would join in.
And, in fact, Kennedy seemed as skeptical as Chief Justice John G. Roberts, Jr., and Justices Antonin Scalia and Samuel A. Alito, Jr. If, as everyone assumes, Justice Clarence Thomas, a sturdy foe of broad congressional authority, voted against the mandate, he and those four could make a majority for a 5-4 result.
Kennedy seemed to have picked up on one of the key arguments by the mandate’s challengers: the provision was not a form of regulating existing economic activity, but was in fact a form of coercion for individuals without health insurance to enter for the first time into economic activity over their objection.
Starting with the assumption that the mandate was “a step beyond what our cases have allowed,” Kennedy told Verrilli that it would change “the relation of the individual to the government in this…unique way.” Thus, he said, Verrilli had a “heavy burden” to justify it.
Later on, Kennedy repeated his concern about changing that core citizenship relationship in a “very fundamental way.” It was not apparent that the Solicitor General, in his responses, had given the “justification” that Kennedy was seeking.
But the atmospherics of the argument changed markedly when two Washington lawyers representing the challenging states and private parties, Paul D. Clement and Michael A. Carvin, took their turns. The Court’s more liberal members – and especially Justice Stephen G. Breyer – took up a fervent defense of the mandate as necessary to deal with the national problem of having nearly 40 million Americans without an assured way to pay for their health care, which Breyer said was burdening the entire health insurance market.
Breyer was joined, but with a little less passion, in that defense by Justices Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, thus indicating that the mandate did have champions on the Court – but only four in number. Only if they could draw Justice Kennedy to their side, it appeared, might they prevail.
The changed tone of the hearing may have had some impact on Kennedy. The next time he expressed his “concern” it was not about the threat to the citizen-government relationship. In a notably softer voice, the Justice said that “most questions of life are matters of degree.” That was an indication, it seemed, that he was developing some flexibility in analyzing the issues surrounding the mandate.
Young and healthy Americans, Kennedy then observed, could, if they have no health insurance, be in a position that was “very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries.” The claim that Congress could do what it did with the mandate because the health insurance industry was unique was a basic argument that Solicitor General Verrilli had made. If Kennedy was now seeing that health care financing is different, his vote might well be available for the mandate.
Although there is no hard evidence to support the notion, it is widely believed that, because of the importance of the health care debate in the Nation, Chief Justice Roberts would not want the Court – if it could be avoided – to decide the mandate’s fate on a thin 5-4 vote. Thus, if Kennedy wound up casting a vote for the mandate, there is some speculation that Roberts might well join in.
In fact, in the second hour, Roberts was reciting – for lawyers Clement and Carvin – some of the government’s basic justifications for the requirement. Although he made clear that those were the government’s points, not his personally, he spelled them out in a way that did not sound as skeptical as he had seemed in the first hour.
The result, though, is not likely to be known until the Justices release their ruling on the mandate, and other issues surrounding the new Affordable Care Act, probably late in June.
Lyle Denniston is the National Constitution Center’s Adviser on Constitutional Literacy. He has reported on the Supreme Court for 54 years, currently covering it for SCOTUSblog, an online clearing house of information about the Supreme Court’s work.
Also ReadThursday, March 29, 2012
The 'Heart' of Health Care Reform: Can the Law Stand Without a Mandate?
During the summer of 2009, when the health care reform debate was dividing the country and the "public option" seemed like the most important policy issue in a generation, the proposal to require all Americans to have health insurance was hardly ever mentioned. The individual mandate, now the focus of a historic Supreme Court review, was just one part of a complex and broad overhaul of the nation's health care system. Medicare cuts, end-of-life counseling and a tax on high-cost "Cadillac" health insurance plans were a few of the provisions that attracted far more attention -- and criticism.
Despite flying under the radar for so long, the individual mandate is now being described by critics as the foundation on which the entire new health care law rests. Thanks to a constitutional challenge, the mandate's future is in peril. Although the High Court won't rule until June and predicting its decision is impossible for even the most seasoned experts, a Supreme Court hearing on Tuesday over the requirement's constitutionality left many health reform supporters worried it might not survive. If it falls and the rest of the law remains, however, chaos could follow, along with a host of unintended consequences like skyrocketing health insurance costs and even less access to coverage than exists today.
(PHOTOS: Supreme Court Health Care Protests in Pictures)
Paul Clement, a lawyer representing 26 states and a small business trade association, argued before the Supreme Court on Wednesday that the entire law, which reorganizes one-sixth of the U.S. economy, must fall if the individual mandate can't pass constitutional muster. Taking the opposite stance, a court-appointment attorney, H. Bartow Farr, argued the Affordable Care Act should be left to stand as is, even without the mandate. Meanwhile, the federal government's lawyer, Deputy Solicitor General Edwin Kneedler, argued that two major insurance reforms -- to end discrimination based on pre-existing conditions and premium pricing based on health -- are too closely linked to the mandate to exist without it. Those must go if the mandate falls, Kneedler said, but the rest of the law should live on.
So what's likely to happen? One possible outcome is that the individual mandate is upheld as constitutional, which would make Wednesday's debate moot. If the Court comes down against the mandate, however, it must then grapple with the interdependency of the law's parts and Congress's intentions when it crafted the Affordable Care Act.
Justice Sonia Sotomayor, of the court's liberal wing, began the questioning during Wednesday's session by suggesting that even if nixing the individual mandate would cause collateral damage, it is a problem for Congress to solve, not one for the High Court to head off. "Why don't we let Congress fix it?" she asked.
Clement, arguing for the states, said federal lawmakers surely would not have wanted the Affordable Care Act to continue in dysfunction without an individual mandate, operating in a way at odds with the goals of the original law. Therefore, he said, it should be wholly struck down, leaving a "blank slate" for Congress to start over again to better address the crisis of rising health care costs. But the health care law is filled with a myriad of measures, some of which have nothing to do with the individual mandate or even health insurance. In what he called a "total off-the-cuff impression," Justice Stephen Breyer, of the court's liberal bloc, pointed out that provisions encouraging breastfeeding, aiding coal miners with black lung, placing doctors in under-served areas and requiring restaurants to publish calorie counts on menus are all elements of the Affordable Care Act unrelated to the individual mandate. Justice Ruth Bader Ginsburg, also left-leaning, pointed to a reauthorization of funding for the Indian Health Services as one such element of the law. Should these just be discarded, Breyer asked.
(MORE: Why Obamacare Supporters Are Getting So Nervous)
Clement responded that if the mandate and provisions "tied at the hip" to the mandate are struck from the bill, all that remains is "a hollow shell" or items "on the periphery" of substantive health care reform. Justice Antonin Scalia, of the court's conservative wing, appeared to agree. "My approach would say if you take the heart out of the statute, the statute's gone," he said.
The justices also engaged in a line of questioning about how the court could decipher which pieces of the health care law Congress would have wanted to pass, with or without the individual mandate. This is a fraught exercise, as Chief Justice John Roberts noted:
This was a piece of legislation, which, there was -- had to be a concerted effort to gather enough votes so that it could be passed. And I suspect with a lot of these miscellaneous provisions that Justice Breyer was talking about, that was the price of the vote. Put in the Indian health care provision and I will vote for the other 2,700 pages. Put in the Black Lung provision, and I'll go along with it. That's why all -- many of these provisions, I think, were put in, not because they were unobjectionable. So presumably what Congress would have done is they wouldn't have been able to put together, cobble together the votes to get it through.Justice Elena Kagan said there was no use trying "to figure out exactly what would have happened in the complex parliamentary shenanigans that go on across the street," referring to Capitol Hill. "Instead, we look at the text that's actually given to us."
This is easier said than done. Drawing hearty laughter from those in the court room, Scalia cited the Eighth Amendment, which bans "cruel and unusual punishment," and said it was ridiculous to expect the justices to go through the Affordable Care Act line by line, determining which provisions might be related to the individual mandate.
You really want us to go through these 2,700 pages?...Do you really expect the Court to do that? Or do you expect us to give this function to our law clerks?... Is this not totally unrealistic? That we're going to go through this enormous bill item by item and decide each one?Justice Samuel Alito, also a conservative justice, said it may be impossible to figure out which Affordable Care Act provisions could remain if the mandate is struck. "Once you've cut the guts out of it, who knows, who knows which of them were really desired by Congress on their own and which ones weren't?"
(VIEWPOINT: Why The Supreme Court Should Uphold the Health Care Law 9-0)
The government's lawyer, Kneedler, argued that the text of the Affordable Care Act draws a bright line between the individual mandate, insurance reforms and the rest of the law despite its complexity. That led Roberts to ask, "How do you know that? Where is this line?" Kneedler contended that the authors of the health care law explicitly said the mandate was "essential" to the health insurance reforms, but did not make this distinction for any other provisions.
Determining what -- if anything -- Congress might have done differently on health reform if the individual mandate had not been under consideration is very close to impossible. This predicament could ultimately limit the justices' options. If the mandate falls, the court may decide it has no choice but to leave the rest of the law intact or strike it altogether.
The possibility of the Affordable Care Act's total demise seems real after this week's arguments, a scenario that has left supporters of health reform befuddled and nervous. A fatal blow removing the legitimacy of President Obama's signature legislative achievement just months before Election Day could damage his political fortunes. On the other hand, if the court upholds the law, either mostly or entirely, accusations that Obama has undertaken an unprecedented expansion of federal government could be deflated.
The justices will soon likely take a preliminary secret vote on where they stand on these issues. Debate among them will continue over the next several months and a final decision is expected in June.
MORE: High Noon for Health Care
View this article on Time.com
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Monday, March 26, 2012
Health reform mandate: What if it goes away?
Is the new requirement that people buy health insurance unconstitutional?
That's the principal question before the Supreme Court this week as it takes up the 2010 health care reform law.
The Affordable Care Act is meant to help more people get affordable health insurance coverage -- including the 49 million uninsured today -- and bring health costs under control. But those goals could be harder to achieve if the court strikes down the "individual mandate."
Just how much harder is not certain.
The individual mandate is intended to work in conjunction with two other new rules in the law: Insurers must offer everyone coverage regardless of health status, and insurers may not charge people with pre-existing conditions more than other policyholders in their geographic area who have the same plan.
The argument goes like this: The mandate, which wouldn't start until 2014, would mean the vast majority of Americans will be insured, and that would reduce the costs imposed by the uninsured on everyone else.
Why? Because the uninsured seek care when they need it the most -- often by going to emergency rooms. When they can't pay for that care, the cost is absorbed by hospitals. The hospitals in turn raise the cost of their services on the insured. And then insurers raise their premiums on policyholders.
Health reform coverage cost falls slightly
The mandate would also reduce premium costs for those who are older or sicker since younger, healthier people would start to buy policies. (CNN: The 4 big issues before the court)
So what would happen if the Supreme Court. which is expected to decide the case in June, finds that the mandate is unconstitutional?
Much depends on how the court rules. If it also finds the mandate is not "severable" from the overall health reform law, the whole law could get struck down and most of the potential benefits from it eliminated.
But the court could also find that the mandate is unconstitutional and can be repealed on its own.
In that scenario, experts say, some premiums would go up and fewer people would have insurance relative to how many there would be with a mandate. On the other hand, these analysts say, neither change would likely be so drastic as to totally undermine the benefits of the law's other provisions.
The Congressional Budget Office last year estimated that 16 million fewer people in 2021 would be insured as a result. The Lewin Group, a health care consulting firm, estimated about 8 million fewer people would be insured overall.
What health reform is (and isn't) doing now
The CBO further estimated that premiums for people who would buy policies on the new insurance exchanges or on their own could go up by between 15% and 20%.
But that doesn't necessarily mean a bigger bite for everyone. Many individuals would still get federal subsidies that would help absorb the premium increases. The Lewin Group estimated that two-thirds of everyone buying insurance outside their workplace would be eligible for subsidies.
That's also one reason why the reduction in the number of insured might not be as drastic as feared without a mandate.
In terms of the federal cost burden, both the CBO and the Urban Institute estimate that without a mandate the deficit would drop -- by $282 billion, according to CBO. That's in part because without a mandate there would be fewer people than expected to subsidize on Medicaid and on the exchanges.
But the bang for the buck that the government would get for subsidizing coverage would go down too, said Matthew Buettgens, a senior research associate at the Urban Institute.
He estimates that the government would spend about 3% less without a mandate, but far fewer people would get coverage than if the mandate stays.
View this article on CNNMoney
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Friday, February 17, 2012
Health Insurance 'Mandate' Deemed Best Value for Money
THURSDAY, Feb. 16 (HealthDay News) -- Doing away with the U.S. health care reform act's requirement that all Americans must have health insurance would not dramatically increase the cost of buying policies through new insurance exchanges, but would significantly reduce the number of people who get insurance, according to researchers.
The findings from the RAND Corporation, a nonprofit research organization, are based on estimates created using a computer model. The investigators found that eliminating the so-called "individual mandate" would increase a person's cost of buying insurance by 2.4 percent and reduce the number of Americans who would get new health coverage in 2016 from 27 million to 15 million.
"Our analysis suggests eliminating the individual mandate would sharply decrease coverage, but it would not send premiums into a 'death spiral' that would make health insurance unaffordable to those who do not qualify for government subsidies," study lead author Christine Eibner, an economist at RAND, said in a news release from the organization.
The analysis also found that repealing the individual mandate would greatly increase the amount of government spending for each person newly enrolled in a health insurance plan. The cost would more than double, to $7,468 per person.
"The individual mandate is critical not only to achieving near-universal health care coverage among Americans, but also to yielding a high value in terms of federal spending to expand coverage," Eibner said. "Without the individual mandate, the government would have to spend more overall to insure a lot fewer people."
The U.S. Supreme Court is scheduled to hear arguments in March about the constitutionality of requiring all Americans to obtain health insurance.
More information
The U.S. Agency for Healthcare Research and Quality explains how to get good value when choosing a health plan.
Health Law Would Not Implode Without Mandate, RAND Study Finds
If the Supreme Court knocked out the health care reform law’s individual mandate, but preserved everything else, the sky would not fall, according to a new analysis from RAND Health.
The study, published on Thursday, looked at the effects of enrollment and premium increases in a universe in which health care reform stayed on the books without the controversial requirement that everyone have health insurance or pay a fine. In briefs before the Supreme Court, the Obama administration is arguing that the mandate is the key piece of a larger regulatory structure that expands coverage without causing premiums to skyrocket.
The experiences of states that have tried insurance reforms without a mandate bear out this argument, and two prior studies of the federal law concluded that prices would go way up and enrollment way down without a requirement to buy insurance.
The argument for the mandate--originally made by conservatives during 1990s-era efforts at health care reform--is that without it, too many younger, healthier people will gamble on going without health insurance, driving up costs as only those with a greater immediate need for insurance buy it.
The RAND report agrees with those other analyses that fewer people would have health insurance without the mandate—87 percent of the non-elderly population versus 91 percent with a requirement. And it also concludes that insurance premiums would increase.
But by looking at the actual premiums new enrollees would pay, RAND finds that prices for most individuals would rise by only 2.4 percent, compared to the 10 percent or higher average premiums calculated by the prior studies. That could be a difference between what some critics have called a “death spiral” of adverse selection and the sort of change that would keep insurance relatively affordable for those who choose to buy it.
The RAND report did not, however, conclude that health care reform without a mandate would be a big bargain for the government. Because more people who bought insurance without a mandate would be old and sick, the government’s bill for tax credits to help middle-income Americans afford their premiums would not go down by very much. If Congress made no other policy changes, the cost would be $109 billion with a mandate versus $99 billion without—a difference in per-person cost of $7,468 versus $3,659.
According to RAND’s Christine Eibner, the report shows that the mandate could probably be severed from the rest of the law without causing calamitous results. But that doesn’t necessarily make it a good idea.
“That depends on your policy goals,” she said.
Monday, February 6, 2012
Health mandate to include birth control
This is a great step forward for the health of all women
The Obama administration recently ruled that health insurance plans must include contraception among the preventive services available to women without deductibles or co-pays under the new health-care law [“Contraception mandate outrages religious groups,” Health, seattletimes.com, Feb. 3].
This decision does not force doctors to prescribe contraception, or a woman to use it. Instead, it makes contraception affordable for many women who otherwise would not be able to afford it. As a nurse, I know this is a great step forward for the health of all women.
Despite the fact that 98 percent of Catholic women use contraception, some in the religious community are demanding that the current exemption for churches and religious organizations be expanded to include colleges, hospitals and social service agencies. This would be a disastrous decision for women’s health.
This issue goes to the heart of the personal-health decisions a woman makes with her doctor and care team, not her employer. As a Catholic, my grandmother died giving birth to her eighth child in so many years, and my mother had 10 pregnancies within less than 12 years. With birth control, their pregnancies could have been spaced so as to minimize the extreme physical, emotional, financial and psychological toll placed upon our family.
As a nurse, I know the decision not to expand the exception was the right one — as a matter of public health, respect for individual conscience and simple fairness to Washington women and their families.
This politicalizing from the pulpit, however, is one of the reasons why I struggle with my Catholic faith.
— Mary McNaughton, registered nurse, Everett
This is a threat to our fundamental freedoms
The recent news about the Health and Human Services mandate gives one something to, shall we say, pause over. I find this move very interesting. For those of us who are disturbed by this mandate, the issue is not simply abortion; it is that our government, while arguing that it is defending a woman’s right to choose, this mandate is going to deny that same right of conscience to those of us, men and women, who believe that all life is sacred, from conception to natural death..
The government, according to our founding documents, lacks the legitimacy, or the power to do what is being threatened by the Health and Human Services Mandate. It does not have the competency to do so.
The disagreement between us in this matter is about much more than just the life issues. We disagree on fundamental Constitutional, democratic principles. The right of conscience applies to all moral, political and social justice issues, not just the life issues. That is why this is, and will continue to be, a legitimate debate, not a forgone conclusion.
This is not just a mandate, it is a mortal threat to fundamental freedoms. You give government this kind of power and you no longer live in a democracy.
— Daniel J. Doyle, Edmonds
Sunday, January 15, 2012
After supporting health care mandate in 1994, Santorum now says he never supported mandates
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