KeriAnn Wells

KeriAnn Wells
March 26
KeriAnn Wells is a Master of Public Policy Candidate at the University of California, Berkeley.


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APRIL 7, 2012 11:36PM

Repeal of individual mandate means loss of affordable care

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flickr-3608394553-hdAmericans seem to overwhelmingly oppose the individual mandate, a provision of the Affordable Care Act, or Obamacare, requiring many Americans to purchase health insurance or pay a penalty. A recent Gallup poll shows 72% of Americans believe the mandate is unconstitutional. However, a Pew poll shows how question wording can strongly influence responses. Disapproval of the mandate dropped 14 percentage points when the question ended with a reference to public financing available to people who cannot afford insurance. This shift resulted in 49% disapproving and 47% approving of the mandate, within the margin of error suggesting Americans are evenly divided.

The Supreme Court heard arguments for and against the individual mandate last week, and are slated to issue a ruling in June. Health policy wonks watching the Supreme Court closely are discussing things like adverse selection, severability, the Commerce Clause and the Anti-Injunction Act. These terms alienate ordinary Americans, who are understandably uncomfortable being forced to buy insurance, but who also want access to affordable health care.

One provision of the Affordable Care Act that enjoys broad support among Republicans and Democrats prevents insurance companies from denying coverage to people with pre-existing conditions. This provision was crafted in response to insurance companies’ rampant refusals to insure people with even minor health conditions in their medical histories. Under the law, insurance companies not only have to cover people with pre-existing conditions, they also have to do so at affordable rates.

What most Americans don’t understand about the Supreme Court case is that if we lose the individual mandate, we also lose the requirement that insurance companies offer affordable policies to everyone, regardless of their medical condition. If everyone isn’t required to have insurance, the theory goes, only the sickest among us opt to buy insurance. This causes medical costs and premiums to increase, further driving healthy people out of the market. This vicious cycle has proven true in states that have enacted mandatory issue laws without also requiring consumers to be covered. Only in Massachusetts, whose law does include an individual mandate, have requirements that insurers  provide affordable coverage to everyone remained intact.

Therefore, a court decision striking down the individual mandate will almost definitely mean the continuance of exorbitant premiums or outright denials for people with even minor medical conditions.

True to form, Obama articulated this trade-off cogently, but the average American still may not understand the choice. Do Americans care more about access to affordable care for everyone or about the perceived affront to liberty that occurs when we are required to purchase insurance? The fact is that we cannot have one without the other. (Unless, of course, Congress were to pass a public insurance option or a single-payer system, which politically we have no reason to expect any time soon.)

This is a question of values, a question that Americans have not been asked. Given the choice, it is very likely that we would prefer to have access to affordable coverage, even if means facing a penalty for not purchasing insurance.

(By the way, the penalty is largely unenforceable. The IRS’s only recourse if individuals do not pay is to deduct the penalty from their income tax returns. A person who refuses to pay will not have a lien placed on their assets, and they certainly will not face imprisonment. Further, Americans who do not file income tax returns, because they do not receive ample income, are not subject to the penalty.)

Unfortunately, this issue is not going to be resolved by an earnest and informed discussion among Americans and our elected leaders. Instead, it will be resolved by one man. That man, Justice Anthony Kennedy, enjoys lifetime job security complete with very generous health benefits funded by yours truly, the American taxpayer. While we uphold his access to affordable care, will he uphold ours? Sadly, he may not, and Americans most in need of health care will continue to be systematically denied.

KeriAnn Wells is an MPP candidate at the University of California, Berkeley. 


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Obamacare is a giveaway to the insurance companies. We need single payer universal health care (Medicare for all) like virtually all other industrialized countries. Everyone gets covered for a lot less money because it cuts out the middle man--the insurance companies, who add nothing of value, other than profiting off of the sick and denying care to the poor.
A well reasoned post but unfortunately, the way people currently feel about it doesn't matter all that much now since its out of our hands as its fate resides in the Court's.

Although should it be upheld then we will need all the reasoned voices out there to educate all those who don't comprehend its benefits.
A well-written, informative post. People are so freaked out about a theoretical affront to individual liberty. And you're right about question wording being totally relevant. I was asked questions in a survey about this topic that were so leading I refused to continue the survey.
I'm so sick of American insane discussions on this topic. Oh jeez, *individual liberty* die in the street or go bankrupt, all the while being screwed over by insurance companies who don't offer *freedom* of any kind... Every other industrialized country has figured this out. Why aren't you rioting in the streets? And yes, those assholes who may repeal or withhold, who yammer on about not encouraging "dependency" - you pay for THEIR top of the line care. RIOT, goddammit.
It is not that people don't comprehend the benefits. It is that forcing people to give their money to a private industry, a private industry that cares nothing about health and everything about profit, is fundamentally offensive. How many people have died because of the actions of a the faceless insurance corporations making their health decisions for them?

Obama could have fought for a single-payer system, but he didn't. Sorry, but coming to the defense of the for-profit insurance industry just strikes me as completely missing the point.
Well, we are forced to have car insurance, what's the difference?

I'm not well informed, but I do know that I was able to purchase affordable health insurance for my son with pre-existing conditions because of the act. That's something I hadn't been able to do or afford before.
This is maybe the most misunderstood concept of our time: the Repubs color it - ObamaScare -- want people to feel that they are paying for something that someone else will benefit from. It has become a referendum against a president that sees programs as a way to solve serious problems. His opposition will hammer at this until the Congress creatures at the public trough will have had their fill, continue using Corporate America $'s to buy votes. There is no way that they can muster enough votes to win -- but they will do anything to stop the Scare. Yet, we have to enter the century that even some of the lesser European countries have. There is a huge cost for people going untreated. And die. Where are our values?
Where do we find ourselves now?
Problem is, keeping the mandate also means loss of affordable care. Costs are only going to continue to shoot up every year, the job of providing care will stay in the hands of private corporations that care only about profit, and this bill does nothing to control either one. It only forces more people into a system that's appallingly callous and dysfunctional, rather than doing a single thing to change it.

The solution isn't a "requirement that insurance companies offer affordable policies to everyone," which this bill doesn't come close to doing anyway. The solution is to eliminate insurance altogether and replace it with healthcare.
Phil I disagree. The ACA requires community rating, in which insurance companies have to charge the same premium for people in the same region who are the same age, regardless of medical condition. ACA also has medical loss ratio requirements that limit insurance company profits. Some people think this will be ineffective, but I've personally spoken to insurance CEOs who say they are holding down premiums to meet MLR. There are also several provisions in ACA that try to get at soaring medical costs, using Accountable Care Organizations, bundled payments etc. The ACA is not perfect, many of us think single-payer would work better. But you can't let the perfect be the enemy of the good. The fact is, ACA marks a great improvement from the status quo, and gets us closer to where we need to be with health care.
I can see you've attracted some of the usual suspects with this post. Many of the claims from the right aren't worth answering.

We have to play the long game in attempting to get the message out on this bill. As short as it falls, if upheld, it's a good thing. Period. If the mandate is declared unconstitutional, we head for uncharted waters. I particularly wonder what those on the left, who advocate for universal coverage, (which I support but know it isn't coming our way any time soon,) will do. Will they enjoy it if insurance companies retain their right to deny coverage because they think it will lead to a new crisis point, which will ultimately lead to universal coverage? Will they mind fighting for another ten or twenty years for universal coverage with no relief in the meantime? Or will they just give up?
I do not believe the Federal Government has the Constitutional authority to legally force somebody to buy something.

That's really all this is about.
Losing the buy-prohibitively-expensive-insurance-or-else mandate, which really is just another corporate bailout, won't cost us health care reform. The mandate was always unconstitutional and guaranteed to fail, since it would have done absolutely nothing to alleviate the problem plaguing American health care: the overwhelmingly expensive cost of private insurance.

Medicare keeps administrative costs down while providing access to health care people rely on. It could easily have been restored and expanded to every American, since Democrats controlled both houses of Congress and the White House at the time Romneycare was rammed through the legislature by Obama. Instead, Obama chose to sell the rest of us out yet again to placate his big corporate donors.
Brian, there are no benefits to be had in Obama-Romney-Heritage-Foundation-care. All it does it force millions of Americans who are already unable to afford private insurance to go bankrupt buying that which they cannot afford. The meager regulations placed on insurance companies will go unenforced. Medicaid is being gutted as we speak with the payroll tax cut designed to under-fund the program, which will necessitate throwing even more people off the rolls.
you can't let the perfect be the enemy of the good.

I'd say you have that backwards. We can't let the (illusion of) good be an obstacle to the perfect.

The healthcare issue is as vital as it is simple. Human beings need care. We have the means to provide and pay for it. The simplest plan also happens to be the most effective, most comprehensive and cheapest one of all, and has the support of majorities among the citizens and the medical profession. If the Republicrats are dead set against it, and the Demicans keep insisting that nearly-meaningless tweaking around the edges of our current system is all that's possible, then they can't be allowed to continue deciding what's possible.

There may be a few good provisions scattered through this giant dog's breakfast of a bill--assuming they'd even be enforced, which as Michael points out is doubtful enough--but it leaves the most crucial things unchanged. It does nothing to control costs (I mean control them rather than simply reducing their rate of growth). It does nothing to allow negotiating of lower drug prices or importing cheaper drugs. It does nothing to make insurance public rather than private. It does nothing to extend coverage to anyone new. It does nothing about the fact that insurance is a for-profit business.

Leaving the present system intact and forcing more people to go bankrupt buying into it doesn't bring us any closer to where we need to be. We as a people are bleeding from a nasty slice through an artery, and all the ACA would do--at best--is slap a Snoopy Band-aid over it.

[Steve K:]If the mandate is declared unconstitutional, we head for uncharted waters.

No, we're just left in the same place we've been all along. Except that now there's been a lot more public dialogue about the whole healthcare issue, and hopefully a few more citizens who've learned to recognize a betrayal of their interests (regardless of which party it comes from).

I particularly wonder what those on the left, who advocate for universal coverage, (which I support but know it isn't coming our way any time soon,) will do. ... Will they mind fighting for another ten or twenty years for universal coverage with no relief in the meantime?

How long will it take to get to single-payer if the ACA is kept? It seems to me it'll take much longer for its provisions to continue working their way through the system and for the population as a whole to truly realize just how much Obamneycare will do to screw us over.

It seems to me the smart thing to do instead would be to start small. Reform won't even get onto the table as long as we've got a Congress and president opposed to it, but it doesn't have to happen nationwide all at once. It could happen in, say, Vermont, where some figures are making a campaign issue out of starting a statewide system by 2014. It'll still take some time for other states to start seeing the numbers and saying "hey, we'll have what they're having." But if we wait for a solution from Washington, we'll all go toes up (no doubt from lack of unaffordable treatments in many cases) before it actually happens.
"Well, we are forced to have car insurance, what's the difference?"

Well, there is a huge difference. Most notably, nobody is forcing you to drive. It's your own choice.

- James from