Repeal of individual mandate means loss of affordable care
Americans 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.