There’s too much legal precedence at stake, too many years of “settled” law, too much potential disruption to the legal system for the Supreme Court to reject the individual mandate portion of the PPACA.
That’s the general consensus of legal experts, and while they could be wrong, I don’t think so.
A quick summary.
There are four separate issues in front of the Supreme Court, with perhaps the most significant the “individual mandate”: the requirement that each of us have health insurance or pay a (rather modest) fine. According to an American Bar Association poll of experts on the Supreme Court; “85% said the act would be upheld, [emphasis added] mainly because they believed the court would find the requirement that all adult Americans obtain insurance coverage to be constitutional.”
Before my conservative friends start railing, don’t assault the messenger. This isn’t a political statement, but rather reporting on what looks to be a general consensus that the mandate will be upheld. [opens pdf]
Moreover, let’s not forget that the insurance mandate was the brainchild of the conservative Heritage Foundation; back in 1989 the Foundation’s Stuart Butler wrote:
“[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself…A mandate on households certainly would force those with adequate means to obtain insurance protection.”
The same expert panel surveyed by the ABA also predicted the Court will:
– not find the challenge to the law is premature (in legal-speak, the issue isn’t “ripe”)
– they will uphold the rest of the law if the mandate is ruled un-Constitutional
– the Medicaid expansion will be deemed Constitutional (24 states have asserted it is not)
As regular readers know all too well, my batting average on these prediction things can be pretty inconsistent, so opponents of the PPACA may well take heart; if I’m betting one way, there’s almost certainly a lot of smart money taking the other side of the wager.
Either way, we’ll have a ruling in early summer. In the interim, health plans are betting the law will be upheld, and are working fast and furiously to prepare.
Mar
26
How is the mandate any different from the requirement that we all pay into Social Security and Medicare, both of which are essentially insurance plans? Isn’t that a pretty definitive precedent?
What if it is overturned? The insurance companies are spending a fortune in manpower and expense getting ready. How will they recoup that
Michael, T. Braseth, George
Thanks Michael for quoting Stuart Butler
He makes an estremely clean, coherent argument explaining why we need the mandate.
This is a argument that conservatives also embraced during the 1993-1994 health reformm debate.
From a conservative point of view, buying insurance is a matter of “individual responsibility.” If you’re not insured, and you fall sick, the rest of us wind up payign for you.
Couldn’t people be required to buy insurance when they become sick? Maybe, if they have the money.
Some are too poor Others just don’t plan– they blow money that they might have used to pay insurance premiums, on vacations, going out to dinner, ordering food in. We all know how easy it is to let money slip through your fingers.
Reuiring that people who can afford insurance buy it is a form of enforced savings to cover future needs. (At some point virtually all of us will need health care–probably very expensive health care.)
T. Braseth– Yes, this requirement is much like requiring that we all pay into Medicare — so that the money will be there when we need it.
Those who oppose the reform law argue that the mandate is different becuase it requires that we buy insurance from a for-profit company. With Medicare we are buying insurance from the government.
Liberals reply: Fine, let’s require Medicare for All. This would mean that we would all be on the governmet’s health plan, with no choices. Many people would be unhappy about that.
George –You’re right. If this is overturned, it will create great uncertainty and real chaos. Insurers have already spent money preparing. They also are spending money covering children suffering from pre-existing conditions.
If the court overturns the part of the law telling them that they must cover these children, what do they do, tell the kids parents: “Sorry, starting in July your child will no longer have insurance?”
Or, starting in July, you will have to come up with another $4,000 a month in premiums to cover your very sick child.
You do all realize that every state has guaranteed plans already, without the PCIP? Why not just subsidize those plans and get rid of the whole mess with PCIP and adding yet ANOTHER layer of ridiculousness? And paying into Medicare is not the same thing. And have you ever DEALT with Medicare? Good lord. A, B, D, Med Sups, Med Advantage, Part D Drugs, etc… you want an entire system based on this model? God help us.
Tim – thanks for the note.
I’d respond that the failure of guaranteed issue, the federal Pre Existing Condition Insurance Plans, and so-called HIPAA plans are one of the drivers behind PPACA.
These plans are either: a) seriously underfunded; b) completely unaffordable ($147,000 for a guaranteed issue plan in NJ); or c) active in name only.
I’m not sure about the mention of Medicare or how that’s germane. Fact is most providers are quite familiar with Medicare; of course the fact that Part D is a financial disaster is also rather important.