An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.
Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but the remainder of the ACA may stand, the Politico.com article anticipates some potentially disastrous consequences.
The provisions of the ACA—some of them already in force—include guaranteed issue, elimination of annual and lifetime limits, and a ban on basing premiums on health status, essentially decoupling coverage and premiums from insurance risk. Without the requirement for almost everyone to have coverage, there will be nothing to ensure that the risk pool contains a large percentage of individuals in good health as well as those with medical problems, and nothing to stop anyone from waiting until they’re sick or injured to demand coverage.
Without a subsequent change to the ACA, the consequences of full implementation in 2014 with no individual mandate would be dramatic jumps in premium rates in the individual and small group markets. These, in turn, would lead to further drops in enrollment, especially by those least in need of coverage, leading to additional premium increases as all but the sick retreat from the insurance market—the classic adverse selection-fueled death spiral.
As premiums for all but major employers shoot through the roof, those unfortunates who work for marginally-profitable small businesses or, worse still, pay for their own coverage will find insurance either unobtainable—as insurers exit the small group and individual markets—or unaffordable.
In a more politically rational world, a possible high court ruling against the mandate would be followed by Congressional action to modify other parts of the law—for example, by modifying the guaranteed issue provision. However, no-one who watched the cliff-edge battle over the debt limit can be confident that extremists in either party would compromise on any reasonable solution. What’s to stop lawmakers from continuing to refuse to modify their positions regardless of the impact on the insurance market? After all, the ACA is anathema to Republicans, while there are plenty of Democrats who despise the private insurance industry and who might be happy to see it close to collapse.
Even leaving political adversarial issues alone, Democrats will not be eager to renege on their promise that health insurance will be available to anyone, while many Republicans may also hesitate to revoke such an apparently attractive provision for fear of a subsequent electoral backlash.
The Politico.com article doesn’t try to guess the outcome, but it’s hard to be optimistic. A reasonable supposition—given the current inflexible mood in Congress—is that there will be no compromise until the insurance market is on the edge of disaster—or maybe already slipping over that edge. Insurance industry lobbyists are likely to find few votes for a rational solution until there is sufficient public outcry over skyrocketing premiums and cancellations of coverage by carriers abandoning the market to put politicians’ reelection chances at risk.
Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies. He is editor of Health Care REFORM UPDATE.
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As someone who has worked in the health insurance business for nearly 24 years, the current situation ( with carriers preparing for the mandate) is worse than it has ever been for the consumer and businesses. Just ask anybody in America with health insurance today if there coverage is either better or less expensive than it was just one or two years ago.
Granted the health care situation in America is very much on the verge of imploding and unless Congress or even better yet we Americans speak up with our votes we might as well call it in.
Just ask those in neighboring countries how they feel about there own health care situation. The mandate will not work because we cannot force someone to buy something controlled by government.
Just my thoughts
5 Good Reasons You Really Should Manage your Blood Work
Would not it be great if you could manage your blood work and take your healthcare options as a personal thing? There are several who asked them selves that very same question, and subsequently decided they would do it. Relatively few people actually take time to think it through very carefully. Most believe that it’s really a lot harder than it is really, so that they never start off. Others believe it will take a considerable amount of work, which makes them lose interest. Still other folks have too much inertia to get up and act.
Now have an epiphany moment and consider the following! Are those legitimate reasons you have even real? Did the reasons you have experience a fair hearing? Was that consideration rational and well balanced? The negatives got covered, but did the positives get equal time?
That line of thinking should be reconsidered. Probably we should simply think about 5 favorable reasons to manage your blood work and the interpretation of those results and get a bit of balanced perspective in to the discussion.
Initially,” Direct to Consumer Testing” has been available to consumers for at least 5 years now. All right, I fully understand how understanding and making sense of Direct to Consumer testing can be confusing. That is most certainly an astute observation. However, think about this, First. Moreover, consider that most people who do learn that the testing is available, find it shocking that they can order their own lab tests.
Second, the lab testing is very affordable. A Complete Blood Count can cost an average of $25. A Comprehensive Metabolic panel or a Lipid Panel could cost as little as $35. Add up the time spent waiting in the doctors office and you will realize that it’s very affordable. The reason that is true is that most insured people will make an appointment to see their doctor and wait 4 weeks before they see their doctor. They than spend an hour waiting in the “waiting room” just so they can get their annual blood work written on a piece of paper by their doctor. The co-pay for the office visit isn’t cheap so when you add this all up, it’s very costly. That’s why it just works out that, time spent waiting to get your lab results has a very poor return on investment ? Time spent waiting to make that second appointment to see your doctor? Time spent in the waiting room a second time waiting to review the lab results with your doctor. Last but not least is the money spent on the copayment for the insurance carrier, again, to see your doctor to review your lab results?
Third, the time it takes to schedule an appointment with your physician and get your lab work ordered, drawn, tested and reviewed could be up to 1 or 2 months. Furthermore, your time is precious and you must ask yourself, is this all really necessary!
Fourth, most Americans can read a lab report and compare their lab result numbers to the reference ranges posted on the lab report. Do we really need a doctor to hold our hands when reading a lab report? Can we not chew gum and talk at the same time. The healthcare industry looks at consumers as clueless and a danger to themselves. This is simply not true.
And last but not least, the accessibility to these lab testing centers is enormous. You may ask your self, “where to get a blood test” is beyond my comprehension. It’s so very simple. All you have to do is type into Google, “Online lab testing” and you will find a dozen online providers that can provide the lab testing services you need. There are over 2,500 lab draw centers all over the US which these online lab testing services make accessible to consumers..
Consider each of those reasons each in its turn, think about how they impact you. These factors create a fairly strong case for why you should manage your blood work and your personal health through online lab services.
Just consider it for a minute. Those points were enough to convince many people before you. Do they really not also convince you to at least do a little research to think about making a change when it comes to managing your own lab testing?
Learn easy methods to better understand and manage your health wellness testing at this time and answer the question of where to get a blood test using this site at http://www.labtestportal.com.
Is it possible that the entire health insurance industry needs to take a look at themselves from a broader perspective? Among leading capitalist democracies, the U.S. is alone in allowing insurers to make a profit on basic healthcare plans. We Americans always feel the need to reinvent the wheel. There are plenty of functioning models out there, such as the Japanese or Swiss healthcare systems. The unfortunate attempts to go backwards, as discussed above, are not useful. Get ready for more change, folks. There’s no going back!
https://www.profit-contact.com/the-elephant-in-the-hospital-room
I agree with you on many points of this article. I work for a large healthcare company in Utah (we also have one of the larger health plans) and issues you discuss around insurers not being able to turn down applicants as well as no life time limits, coupled with no mandatory insurance legislation scares the hell out of me. In your article “Clueless in Utah,” all I can say is that at least we tried. It is a lot more than others have done. If other states gave it a shot, we would have more models to compare as we look for an ideal way for dealing with this component of the ACA. Since we already knew this is heading to disaster, do you have any thoughts on a solution?