Earlier this week, as the Supreme Court continued to mull over which of the four legal challenges to the health reform law they will choose to tackle, I found out that, in fact, there could be a “silver lining” to the repeal of the individual mandate—the requirement that all Americans purchase health insurance.
In a post on Politco, Jennifer Haberkorn writes that some “Democrats and supporters of the law” believe that if “the least popular part of the law goes away, they think what’s left could become stronger and more popular with the public.”
And who are these Democrats and supporters who take such a rosy view of what could be a huge disaster for Obama’s health law? The article quotes “strategists” and “pollsters” whose main concern is whether the President will be reelected next year. These folks, who supposedly are taking the pulse of Americans, report strong support among consumers for some of the Affordable Care Act’s provisions like guaranteed coverage for preventive care, maternity benefits, and the ability to keep children up to age 26 on their parent’s health plan.
Sure, these are popular provisions, but they are not the most important parts of the ACA. The real power to transform health care and extend coverage to the 50 million uninsured is the requirement that no one be denied affordable insurance because of age, pre-existing condition or sex. It is also vitally important that the government offers subsidies to those who can’t afford premiums, and that Medicaid is extended to cover the working poor who make up the largest group of uninsured. There are many more provisions of the health law that we’ve discussed in great length on this blog over the last two years; reforming Medicare and the way services are delivered; increasing funding for community health centers; and insurance exchanges that allow consumers to choose coverage that best fits their needs.
Without the individual mandate, many of the so-called “popular” parts of the health law become unaffordable and unlikely to come to fruition. Without every one “in the pool,” a significant number of the young, healthy, so-called “invincibles” will opt out coverage, while the majority of those who are sicker, older and utilize the most services will opt in. Like we just saw with the ill-fated CLASS Act and long-term care, without a mandate, real, transformative health reform becomes impossible.
While formulating my own response to the absurdity of the “silver lining” reasoning, I came across a great piece by Aaron Carroll at The Incidental Economist site that puts the whole silver lining argument to bed:
Carroll writes, “I have yet to see any convincing data that show there’s a significant portion of America that loves the ACA, but hates the mandate. I see no politicians running on a platform of removing the mandate, but leaving the rest of the law intact. I see no reason to believe that dropping the mandate will do anything to increase support for the President, the Democrats, or the ACA.
“But that’s besides the point,” he continues. “The politics are silly. What matters is what will happen to actual people.”
Carroll fashions some simple, yet compelling graphs using data originally derived from this post by Jonathan Gruber at The Center for American Progress to show how getting rid of the mandate will increase insurance premiums, while at the same time decreasing the number of people who will be covered.
Insurance premiums will go up, by an average of 25% over the next decade if we repeal the individual mandate:
And the number of uninsured now covered will drop from 32 million under the ACA to 7 million without the mandate:
The bottom line is that there is no sliver lining if the Supreme Court strikes down the individual mandate. It is a necessary part of the health legislation and repealing it will not signal the end of the other provisions signed into law last year. It will be very difficult for opponents to dismantle the ACA—but without the mandate, the financial viability of universal health coverage becomes far less certain.