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Join the Conversation: What do you think about the individual mandate?

Posted by Valerie Arkoosh, MD, MPH January 26, 2011 at 12:03 PM

The individual mandate to purchase health insurance is one of the most contentious provisions of the Affordable Care Act.  Many believe it is necessary to reduce the number of uninsured and the corresponding amount of uncompensated care.  Starting in 2014, it will be paired with premium tax credits to help middle and low-income families afford insurance.  It is also seen as an integral part of the requirement that insurance companies cover pre-existing conditions; otherwise people might wait until they became ill to purchase insurance, weakening the insurance risk pool.

However, many opponents feel it is unfair to force people to purchase insurance when a competitive and not-for-profit public option does not exist.  Still others believe the mandate is simply unconstitutional and that steps can be taken to reduce adverse selection in insurance risk pools.

Post a comment below and tell us what you think about the impact of the individual mandate on your patients, your practice, or on you.

For opinions on both sides of the issue, check out:

The Urban Institute: Why the Individual Mandate Matters

Ezra Klein, A World With an Individual Mandate

Merrill Mathews, Why Obama Should Drop the Insurance Mandate

The Heritage Foundation, Obamacare and the Individual Mandate: Violating Personal Liberty and Federalism

5 Responses to “Join the Conversation: What do you think about the individual mandate?”

  1. Mark Ryan says:

    From my understanding, the only way we can get insurance companies to agree to cover all regardless of pre-existing conditions is to make sure that everyone has insurance coverage. If we are to structure our access to health care through for-profit insurers, then this is a necessary step: the insurers will not agree to insure all patients (even those with existant medical problems who will require care (and incur costs) unless these costs are balanced by increased income.

    The individual mandate is also important to make sure that costs in the system are shared by everyone. As the situation currently stands, if a patient is uninsured but requires hospitalization or ER care, then it is unlikely that the hospital or ER will recover all of its costs. The medical facility may then increase its overall fees as much as it is able in order to cover its losses, and will charge private insurers those higher fees. The insurance companies will then pass along these higher fees to the rest of us in the form of higher premium costs. I have heard estimates that nearly $1,000 of a family’s insurance premium results from the care provided to uninsured individuals.

    Claiming that one should be able to choose to go without insurance coverage would only work if 1) the person without coverage NEVER received medical care (even in case of emergency), or 2) if the uninsured person could pay for ALL their care costs out of pocket. Neither of these is a likely scenario, meaing that unless everyone is covered, costs will continue to be shifted to those with insurance coverage.

    The individual mandate, then, is a path to increasing the fairness in the system. The fact that there are plans in place to help low-income families afford this coverage will allow true access for most American citizens.

  2. Larry Buxbaum says:

    The issue of constitutionality is really a semantic issue not a real one. Instead of calling it a mandate for health insurance, if it were a tax then it would certainly be constitutional. To make it a tax one would likely need a public option for those who are mandated to get care. Otherwise it would be a messy system to have a tax that then paid for private insurance.
    In general it is hard to imagine a system that covers anyone with a pre-existing condition but does not require everyone to be covered. People could wait until they are sick to get insurance, thus raising the cost for everyone. The uninsured consist of two groups- the poor, who feel they cannot afford it- they need subsidies, and hopefully are getting them with health care reform- and the rich who feel they can self-insure. Even if it is not a “good deal,” the rich can afford to get insurance even if they don’t want to.

  3. eric henley says:

    An article from yesterday’s NEJM: analyzes data from Massachusetts’ experience with health reform and shows that the presence of an individual mandate led to greater enrollment of healthier beneficiaries. This provides support for the argument that the individual mandate expands the insured pool with healthier enrollees, thus allowing the many private insurance reforms Americans want.

  4. Lisa Plymate says:

    The individual mandate, the requirement that everyone participate in paying for their health insurance, is essential for reform. It is too bad this derogatory term is being used; it would be preferable to speak of “everyone’s responsibilities in securing their own health care.” Our goal is for universal coverage – everybody in, nobody out.
    That ‘everybody’ applies to both paying in and to receiving. For those who want our laws to go further, to include single payer, remember that in Canada everyone who can afford it pays into the system. For those concerned that this responsibility takes away a personal freedom, ask yourselves what our lives would be like if only some of us paid for our fire department or police. We expect that protection, and we’re all willing to pay for it. Isn’t health care similar?
    Clearly there are still major issues of affordability, in Massachusetts as in the entire country, under a provision that makes carrying protection obligatory. We need to address these concerns and assure that everyone is able to purchase plans. But we sacrifice significant cost savings and return to cost shifting if we do not require participation.

    As a provider, I want all my patients covered. I want to be able to treat each patient based on their health care needs, not on whether or not they have insurance. I am tired of cutting corners in my evaluation and management – How can I meet the community standard of care if I face patients who are paying out-of-pocket and simply cannot afford the workup or treatment I know is most appropriate for their situation?

    As a patient myself, I expect to pay in advance, to assure that I can have the care I need, and to assure that my family does not risk going broke should I develop a major illness. And as a citizen, I want everyone to have that same privilege to participate in our health care system.

  5. Lee Ann Hoff says:

    To me this is a “no-brainer” in that no one similarly questions the mandate for car insurance, implying that the health of our minds and bodies is inconsequential in comparison. And speaking of “mandates” there’s a human rights issue of “duty” to care for the sick regardless of ability to pay, as in those coming to or brought by ambulance to an emergency room, and we the taxpayers getting to “pick of the bill” for the uninsured and those unable to pay. Yes, there are a few millionaires stating they can pay their own bills, but their assumption appears to be that the majority of uninured folks are rich like themselves.

    Let’s start making much more public the total incongruity of arguments regarding this “controbersial” issue.

    Lee Ann Hoff

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