Robert A. Levine 4-23-12
Whether the Affordable Care Act (ACA), now before the Supreme Court, will survive in its current
form is in some doubt, with the individual mandate particularly in danger of being overturned. Though Congress has the power to regulate interstate commercial activity, opponents of the law believe it can not impose a tax or fee on inactivity, such as the failure of citizens to purchase health insurance.
The individual mandate was included as part of the law to pressure young healthy people to obtain insurance. This was to balance the cost of insuring men and women with chronic illnesses and pre-existing conditions. Without the mandate, it was believed many young Americans would not bother with coverage, as is currently the case. If that happened, writing policies for those with pre-existing conditions would not make financial sense for the insurance companies, or the premiums would be too expensive for those who were sick.
Many individuals in their twenties and thirties do not see the need for heath insurance, assuming they are unlikely to become seriously ill or injured and that it is a “waste” of money. They know that if necessary, they can always receive Emergency Room care without insurance, and think they will be able get coverage after the fact. And if medical expenses become crushing because of a major illness or injury, the involved person (having limited assets) can simply declare bankruptcy, erase the debt and start over. This is a prime example of moral hazard, where the economic risks of illness for uninsured people is placed on the backs of others.
Health insurance allows individuals to receive care without having to worry about financial ruin in
case they are faced with unexpected medical expenses. An immediate expenditure of funds to buy coverage guards against the possibility of much greater losses in the future. Carrying health insurance requires men and women to take responsibility for their own well being and not be dependent on the social safety net should they fall ill. It is unfair to other citizens for uninsured people who can afford coverage to receive medical care. It means their care is paid for by government subsidies to hospitals (which is bourn by taxpayers) or by an increase in insurance premiums for all policyholders. However, as long as men and women know they can obtain medical treatment in Emergency Rooms or walk-in clinics, and that they will be hospitalized if necessary even without coverage, there is less incentive for them to purchase insurance. And bankruptcy is an easy way for young people who have not yet accumulated significant assets to discharge debt.
If the ACA or the individual mandate is voided by the Supreme Court, a way must be found to persuade reluctant citizens who have the financial means to buy health insurance. A law that prohibited medical facilities from providing care to those who did not have coverage would certainly be effective, but this is a non-starter. It contravenes societal and medical mores about treating sick or injured patients regardless of economic circumstances. A more realistic approach would be to enact a law that prevented medical expenses incurred by uninsured men and women from dismissal through bankruptcy. Citizens who were irresponsible and neglected to obtain insurance would be indefinitely liable for all their medical expenses, eliminating some degree of moral hazard.
If this measure were passed, those who were too poor to pay for coverage would enroll in Medicaid and those who could afford it would be more inclined to purchase insurance. Allowances would have to be made for people who were emotionally disturbed or mentally impaired.
Though not a perfect answer, the above strategy is a logical approach to the problem of citizens who choose not to purchase health insurance, shifting the cost of their care onto the government and those who have coverage. If the individual mandate or the Affordable Care Act is overturned, Americans who are not obtaining health insurance might be motivated to do so by legislation that does not let them off the hook for the medical expenses they incur.
Resurrecting Democracy
www.robertlevinebooks.com
Whether the Affordable Care Act (ACA), now before the Supreme Court, will survive in its current
The individual mandate was included as part of the law to pressure young healthy people to obtain insurance. This was to balance the cost of insuring men and women with chronic illnesses and pre-existing conditions. Without the mandate, it was believed many young Americans would not bother with coverage, as is currently the case. If that happened, writing policies for those with pre-existing conditions would not make financial sense for the insurance companies, or the premiums would be too expensive for those who were sick.
Many individuals in their twenties and thirties do not see the need for heath insurance, assuming they are unlikely to become seriously ill or injured and that it is a “waste” of money. They know that if necessary, they can always receive Emergency Room care without insurance, and think they will be able get coverage after the fact. And if medical expenses become crushing because of a major illness or injury, the involved person (having limited assets) can simply declare bankruptcy, erase the debt and start over. This is a prime example of moral hazard, where the economic risks of illness for uninsured people is placed on the backs of others.
Health insurance allows individuals to receive care without having to worry about financial ruin in
If the ACA or the individual mandate is voided by the Supreme Court, a way must be found to persuade reluctant citizens who have the financial means to buy health insurance. A law that prohibited medical facilities from providing care to those who did not have coverage would certainly be effective, but this is a non-starter. It contravenes societal and medical mores about treating sick or injured patients regardless of economic circumstances. A more realistic approach would be to enact a law that prevented medical expenses incurred by uninsured men and women from dismissal through bankruptcy. Citizens who were irresponsible and neglected to obtain insurance would be indefinitely liable for all their medical expenses, eliminating some degree of moral hazard.
If this measure were passed, those who were too poor to pay for coverage would enroll in Medicaid and those who could afford it would be more inclined to purchase insurance. Allowances would have to be made for people who were emotionally disturbed or mentally impaired.
Though not a perfect answer, the above strategy is a logical approach to the problem of citizens who choose not to purchase health insurance, shifting the cost of their care onto the government and those who have coverage. If the individual mandate or the Affordable Care Act is overturned, Americans who are not obtaining health insurance might be motivated to do so by legislation that does not let them off the hook for the medical expenses they incur.
Resurrecting Democracy
www.robertlevinebooks.com
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