Congress will almost certainly get another opportunity to revisit health care reform. A survey from the American Action Forum released last week shows that a majority (57%) of the Supreme Court’s former clerks and attorneys expect that the justices will strike down the individual mandate in the Patient Protection and Affordable Care Act (PPACA).
Whether the Court finds the mandate severable from the rest of the law is another issue, but if the mandate falls many of the law’s other provisions will have to be reconsidered or scrapped - simply because the core of the law, heavily regulated private health care exchanges funded with public subsidies, require an individual mandate to function.
In states like New York, that have no mandate and Obamacare’s core insurance regulations, guaranteed issue (no one can be turned away because of pre-existing conditions) and community rating (the young and healthy pay the same price as older, sicker insured), individual insurance markets have collapsed as prices for healthy young people spiked, pushing them out of the market and leading to yet more insurance premium increases, a phenomenon known as a “death spiral.”
Even if the federal mandate is upheld, it is a weak mandate – and the market may collapse anyway. Many healthy uninsured will find it cheaper to pay the mandate penalty ($695) than pay thousands in annual insurance premiums. The law’s fully implemented cost – pegged at $1.76 trillion by the Congressional Budget Office – is also unsustainable given the need for Congress to bring the deficit and the debt under control without crippling the economy through massive tax increases.
Congress must recognize that health care isn’t one problem, amenable to a single silver bullet solution. It is many problems, each requiring a nuanced approach. Take the problem of the uninsured.