Gutting Healthcare Reform of the Individual Mandate

Previously published on Jan 6, 2011

Less than a year after landmark healthcare reform legislation was enacted, a federal judge overruled a key provision requiring all Americans to buy health insurance. Refusing to declare the entire law unconstitutional, as opponents had hoped, the tentative loss of this mandate is seen as a setback by many. From the perspective of for-profit healthcare insurance providers, this is certainly a reality; however, it does not mean Healthcare Reform is dead in any shape or form.

The individual mandate may have been central to the economic justification for other provisions, most notably banding the use of the preexisting condition exclusion, but its true role in reform was as a bargaining chip to disarm the insurance lobby. Since the successful passage of comprehensive legislation, future healthcare reform efforts cannot simply be delayed. In other words, paying to cover those previously uninsurable instead of simply ignoring their needs takes over the cost cutting process.

Ironically, the individual mandate was originally proposed by Republicans as part of a compromise rejected by Democrats in the 1990's and originally dismissed by then candidate Obama during the 2008 Presidential Election. For GOP conservatives working to derail reform before Americans can grow accustom to their new benefits, the defeat of this single provision appears to mark a success. Then again, it might actually translate into a victory for reform proponents. That is, if other provisions can be sustained as is expected.

The individual mandate to buy health insurance was always a difficult provision to justify in terms of government overreach. The Constitutional question revolves around whether or not the Federal government has the right to force people to obtain coverage. Had there been a default public option for everyone to enjoy, this question would have likely been nullified. Taxing or fining anyone who fails to purchase heath insurance is another story as government does not have the right to force people to spend money nor can it simply tax someone for exercising their rights.

If the ruling is upheld by the US Supreme Court, insurance companies looking to redesign for-profit schemes in an environment where coverage cannot simply be dropped or inflated, may well eventually push for a basic public option, so they can offer supplementary benefits at a profit. Containing costs and paying for coverage into the future continues to be the maintain concern, yet the healthcare system must contain costs while caring for everyone in need instead of focusing on increasing profits. Moreover, defeating the individual mandate may not actually be a win for those looking to undo Healthcare Reform. In fact, it might be a win for those in favor of it.
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