• Health reform can survive without the mandate

    Kevin Outterson and I have teamed up for a Kaiser Health News column.

    Some claim that, without the mandate, the overhaul will collapse. Opponents certainly hope that is true, and Judge Roger Vinson of the Northern District Court of Florida decided to void the entire law on that basis – explaining that the measure’s other provisions cannot be separated from the requirement to buy insurance. Even the White House and its lawyers have on occasion agreed, perhaps only as a rhetorical device. But they are mistaken. Health reform can survive without it.

    The rest is here.

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    • In this article, the premise that the risk of those delaying coverage until after they get sick is only limited to the 16 million or so uninsured that will obtain coverage under the mandate is flawed.

      We have clearly observed behavior in other markets where formerly insured persons, once presented with guaranteed issue coverage in their location, dropped coverage and only re-acquired when they became ill. In reality another 17 million or so folks who carry Individual Coverage today will have the option of dropping it without the mandate if they can re-acquire without penalty.

      In addition, once the Exchanges open, we believe large swaths of employers with less than 50 employees will cease to offer coverage and point their employees towards the new Exchanges where they will be eligible for substantial federal subsidies to purchase quality insurance in a G.I. environment. To date, 35 million head of household wage earners are employed by companies with less than 50 employees, and fully 35% of them do not get their coverage at their job today. That’s another group of tens of millions who could economically benefit from delaying purchasing coverage until needed.

      I think your actual risk pool here is not 16 or 17 million but more like 30 to 35 million Americans who could potentially benefit from G.I. coverage without a mandate, making the reasons for the controls you mentioned (especially very limited enrollment periods, not with fines, but with outright denials of coverage outside of those times) even more urgent.

      WellRead29
      Healthcare Economist.

      • @WellRead29 – There are a lot of assumptions in your comment, which you acknowledge (“we believe …”). They’re not universally held or fully supported by the evidence, as I’ve posted before.

    • @Wellread29
      Good UI brief on your comments. ‘

      http://www.urban.org/UploadedPDF/412295-Employer-Sponsored-Insurance.pdf

      NEJM RAND assessment in 2010 also noteworthy, dont have link handy.

      Speculation, estimattions, best guesses, etc on both sides.

      Brad

    • With all due respect, the Urban League has never had to earn a living by close examination of the long term results of their studies or assumptions. I have had to live and die by my estimates. In the private sector. Without policy wonks to run interference for me. Nor do my estimates serve any political cause or particular financial master’s wishes. I am the most independant voice you will find.

      Trust me. UL is vastly underestimating the number of very small groups (under 50 lives) that will see the Exchanges as salvation of plans they could no longer afford. On the appropriate day, i’ll be thrilled to reveal my sources and research, but too soon, too soon.

      Note, I am agreeing with your premise that there are other ways to preserve reform even without the Individual Mandate. I am simply presenting my case to ratchet up the urgency of alternate solutions in the absence of a mandate. This will be critical to the financial security of the medical provider system, which we all know cannot survive long term on what Medicare (or heaven forbid Medicaid) pays for services.

      Trust me.

      WR29