Health Care Mandate Will Affect Few, Study Finds

WASHINGTON -- Just 2 percent of the U.S. population would be subject to the aspect of health care reform at the center of a constitutional challenge before the Supreme Court this week -- the individual mandate, a study released Monday by the Urban Institute found. The analysis said 98 percent of Americans would either be exempt from the mandate -- because of employer coverage, public health insurance or low income -- or given subsidies to comply.

Including those who are subject to the mandate, but would get subsidies, increases the total number of people affected to 5 percent of the population, according to the Urban Institute, a non-partisan policy research organization based in Washington, D.C. (Some of those subject to the mandate who get subsidies would still need to dig into their pocket to cover the difference.)

Opponents of the mandate argue that it infringes on personal liberty by requiring the unwanted purchase of something from a private entity. Backers say the mandate is constitutional because everyone consumes health care services at some point, so it is reasonable to tax people who consume care without paying for it.

The Urban Institute study indicates that such a tax, or fine, would be levied on a small population.

Health care reform prevents insurers from discriminating against patients with pre-existing conditions and caps premiums that can be charged. The only way to accomplish such reform, backers say, is to require healthy people to insure themselves, rather than wait until they get sick.

The court spent Monday debating whether to delay a decision in the case, with the justices appearing to be intent on ruling this year.

Tuesday the court weighs the constitutionality of the individual mandate. HuffPost's Mike Sacks reports:

During today's two-hour argument -- twice as long as the 60 minutes the court usually allots each case -- the justices will pepper each side's superlawyers with questions that will give public hints of how they will ultimately decide the case by late-June.

The court's four Democratic appointees -- Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, and Elena Kagan -- are all expected to side with Solicitor General Donald Verrilli's primary argument on behalf of President Barack Obama's administration that the mandate falls within Congress' broad power to regulate interstate commerce. The inevitable consumption of health care services by the uninsured, Verrilli will argue, substantially affects the national insurance market by shifting costs to the insured and creating the problem of skyrocketing premiums that the Affordable Care Act was designed to solve.

Justice Clarence Thomas, on the other hand, need not break his six-year streak of silence at oral argument to reiterate his oft-written antipathy towards the New Deal precedents Verrilli's argument draws upon for support.

So while there is always a vanishingly slim chance that one or two of the liberal justices will surprise the public with some pointed questions for the solicitor general, it is more likely that they will try to win over their remaining four conservative colleagues by putting the screws into the challengers' lawyers.

Comments

[alex12345]

11:30 AM on 03/29/2012

What are the GOP alternative to cheaper n affordable coverage for all?
People should not be dying in this country because they couldn't afford their sickness.
IF TAIWAN can insure everybody with quality care the USA should be able to do better.
I think Single payer should be the Answer to this problem.

[Hallucinocynic]

09:26 AM on 03/29/2012

Part two of response to Le Roi...

3. Establishment of rate schedules

For any libertarian, this suggestion should send up the red flag. WHO establishes the rate schedules? WHO enforces them? WHO mediates the inevitable litigation? Is this MORE government intervention or does the market govern itself? (Should hear a hearty laugh after that last question!)

4. Tort reform

A lot of what you state is true with no need for refutation. However, the very notion of tort reform raises the same questions found in point #3: that is, WHO is going to determine the margins of tort reform. As Belli once said: It's not as important to know the law as it is how to use the law. Universal tort reform is desirable, but it is not practicable, perhaps for the very reason you suggest: a large number of sitting representatives are lawyers, though I believe the real reason tort reform won't occur is because it will be difficult to topically define, much less establish the margins.

Now, perhaps this is not the 'plan' to which you refer. If not, educate me. I went through nearly 200 of your posts in an attempt to find and learn from the plan to which you alluded. I think what's interesting about this vitriolic exchange is that we agree on many things. But I still don't see a 'plan.'

[Hallucinocynic]

09:22 AM on 03/29/2012

Le Roi Sans Sa Reine said: "I have posted my ideas, my alternative, my plan elsewhere on this blog. I can't post it every time or everywhere so I'm sorry if your feelings got hurt that I chose not to post it here in the thread on which you and I tangled. You could find it if you wanted to, but you won't cuz ya don't..."

Well, I took the time to read through your commentary (and for someone who claims to NOT be a Republican your comments are 95% anti-Democrat/liberal/progressive - a LOL backatacha!) and I believe I found your "plan" expanded over four posts. While I agree, superficially, with your positions (which do NOT constitute any real plan), I will address your four main points of argument:

1. Outlaw group insurance

Topical economic efficacy of group insurance might be better, it might be worse, than it was when it was first introduced during the depression as a means of getting health care coverage to a larger percentage of the population. You provide no specifics, only conjecture.

2. Outlaw kickbacks

In total agreement. The relationship between practitioners and pharmaceutical companies is especially egregious, and too many feeders have been built into administrative/bureaucratic costs. HMOs are being more closely looked at, but the fact remains that a healthy percentage of costs are unwarranted.

End of first response...

[Silverado Lady]

03:18 AM on 03/28/2012

Once again, the use of SCARE tactics by the GOP has blinded the American people to the TRUTH.

[keinangst]

02:08 AM on 03/28/2012

Question...Why have companies like Walmart not shown support for Obama care?

[GoGo As]

11:01 PM on 03/27/2012

Here's my question...Since the plan was to cover the uninsured, why didn't we just make a plan to cover them. The law does nothing to control costs. Its a pipe dream that insurance companies will lower premiums. They are for profit companies. Also, this will be a chance for some large employers to drop their health care plans. the penalty is so small its actually cheaper for them to do so then to continue to carry their plans.

[OldTulsan]

10:54 PM on 03/27/2012

http://www.truthdig.com/cartoon/item/individual_freedom_mandate_20120327/
Individual Freedom Mandate - Truthdig

[Sanity Inspector]

10:27 PM on 03/27/2012

Whoah, whoah, whoah! For three years we've heard that people are dying in the streets because 40% don't have insurance. And now the individual mandate is no big deal because only 2% would be forced to buy insurance? Howdyafigger?

[Ted Glass]

11:00 PM on 03/27/2012

47 million, not 40%

[SOproud]

09:49 PM on 03/27/2012

In case all these people against the "the mandate" don't realize it, I would like to point out that seniors are already "mandated" to sign up for Medicare Insurance when we turn 65 and we are also "forced" to pay at least $97 a month [$1164.00] for that coverage. We are also subject to tax on that $1164.00 that we never see in our social security check. May seniors like myself are in reasonably good health for many years and therefore "use" few services from Medicare, other than the annual checkup. So how is that any different from requiring younger people to have insurance? Why should seniors have to pay for those who don't want to buy insurance?

What drives up Medicare costs are these seniors who insist on being kept alive by being hooked up to every imaginable machine when these extreme measures do not in any way improve their quality of life. Personally, I think there are much better things waiting for me in the next world instead of staying in this one flat on my back with some machine doing the breathing for me. Medicare costs could be greatly reduced if the elderly would simply make their wishes known to their doctor, but of course we can't even have the discussion because that would mean we might have DEATH PANELS. My advise is everyone should have a "Living Will" so your wishes are clear even if you can't speak for yourself.

[Kurfco]

10:15 PM on 03/27/2012

Actually, you are not "forced" to sign up for Medicare. If you want it, you have to sign up for it before you turn 65, but you don't have to take it. It is completely optional and voluntary. You will, of course, have paid in for it over the course of your working career.

[its miller time]

09:42 PM on 03/27/2012

McConnell, I've got nothin...

[DRaymond]

09:35 PM on 03/27/2012

The fundamental assumption in the health care debate is that without an individual mandate healthy people will not get insurance has never been tested and is not borne out by easily observed facts.

If you talk to uninsured people why the are uninsured the overwhelming thing you hear is 'because I can't get it' and 'because I can't afford it', You don't hear 'because I am healthy'.

If young healthy people did not care about insurance then they would not be interested in having it be part of a job benefits package.  They would be saying things like 'yeah, this job has no medical plan but I am young and healthy so no big deal'.  I have never heard anybody say that before.

If young healthy people did not worry about having medical coverage then the part of Obamacare that allowed them to stay a part of their parents' family coverage to a later age would have been unutilized rather than the one early feature of the program that has affected the most people.

Healthy people know that accidents, natural disasters, and violence hit healthy people too.  And even if 'insurance that you can buy in the ambulance' were a reality you have to gamble on the fact that you will be conscious enough in the ambulance to make an application!

There is every indication that if insurance was affordable and accessible that healthy people will buy it.  A coverage waiting period of a little as a few weeks would most likely be enough to dissuade people from gambling on waiting until they are sick.  A couple of weeks of hospitalization costs after an accident is a pretty powerfull financial risk.

[Ted Glass]

11:07 PM on 03/27/2012

You are talking about reasonable adults that understand what's at stake. I fear that a significant portion of the people that make up Uncompensated Care in this country are the irresponsible and shall we say, unreasonable variety.

[DRaymond]

12:41 AM on 03/28/2012

There are nearly fifty million uninsured Americans!  Your really think that large of a percentage of the country is clueless about the risks to their safety?  You really think that the uninsured are simply people too stupid to realize that they ought to be covered and not people who can't get covered or can't afford it?

[KMoore4318]

09:23 PM on 03/27/2012

Why is everyone so surprised Obama promised us change, he never said we would like it. Now we’re getting change. I'm sure the next guy will change it again. Simple answer, if you’re for this vote for him, If not vote against him. If the debt is going the direction you want vote for him, if it's not vote against him, if you think he's making us stronger vote for him, if you think he's destroying us vote against him. Time will tell us who was right, and who was left.

[luvobama]

09:31 PM on 03/27/2012

Obama 2012!!!  Thank You!!

[its miller time]

09:37 PM on 03/27/2012

Change is very hard to achieve with OBSTRUCTIONISM wouldn't you agree?

HCR will happen under Obama.

How have the Republicans told you they are going to run government without spending money and collecting no Revenue?

It's a given...he won't even have to leave to office to be able to remain there...but one has to go through the motions don't they...

[VPerry24]

08:09 PM on 03/27/2012

Most goes in effect come 2014 but already we have seen success. Typical to shoot himself in the foot Mr. Joe Average, who has no idea what the bill stands for. Sure, it needs work but it is a step in the right direction. Without it, what have you got. People can't afford to see the doctor.

[The Great Intellectual]

08:09 PM on 03/27/2012

Funny now Liberals say 2% is small and no bother but when it comes to the EPA regulation that will apparently stop .00007% of the population from a Premature Death(whatever that is) that it is a huge number. Typical Liberals

[its miller time]

09:40 PM on 03/27/2012

What do you find difficult to accept here...that EPA is necessary...or figure of 2%?

[marioninreno]

09:43 PM on 03/27/2012

and you call yourself the great intellectual.. not! amazes me that the bloggers who say the most ridiculous things have the most conceited names!

[TLHemlock]

07:39 PM on 03/27/2012

I really don't get it. We all have to pay into Social Security Insurance. No one is taking that to the Supreme Court. Isn't it an individual mandate? This whole conversation is patently ridiculous. If the Court strikes down the individual mandate for health insurance, then they must also strike down Social Security in its entirety. Let's see how well that goes over. In an election year, no less.

[anelder]

08:04 PM on 03/27/2012

It appears that on the left they object to having to buy insurnce from a company, on the right they see it as a slippery slope to "having to buy broccoli". The one is holding out for government insurance like social security, medicare, or single payer. On the other side they are so government they don't see that this is just the same as SS. and Medicare, something they really want to hold on to.

On the left their ignorance is their own, on the right they are believers in their masters and that means seeing the president as the 'great devil'. Go figure.

[TLHemlock]

08:32 PM on 03/27/2012

I'd like to clarify my personal position as one of the "left". I don't object to having to buy insurance from a company. Yes, I would prefer a single payer system, which would cost less and be more effective than the current ad hoc system that we have in place. How many insurance company horror stories have we all heard in the past few years? However, I believe that the ACA is at least a step in the right direction.

As for the right objecting to an individual mandate; they didn't seem to have a problem with it when they proposed it in the 90's. (See Dole, Gingrich, and even Romney, although he tries to run from it now.) So, as you stated, the real issue for the "right" is that President Obama signed off on it.

It's all more than a little bit silly.

[CTtransplant]

09:17 PM on 03/27/2012

And the same can be said of car insurance, TLHemlock!  And the sad things is - if AHCA IS struck down, it gives Republicans the ammunition to go after SS...which they've wanted to get rid of for a while now!  

[TLHemlock]

09:41 PM on 03/27/2012

Well, the thing about car insurance is you could always not drive. At least, that's the argument that I've heard from the right wingers that I've talked to. "Driving is a privilege, not a right". Oookee, but I'd like to see someone living in a rural area get around without a car. Nevertheless, the point about SSI is unassailable, in my eyes. I'd really like to hear someone try to argue how SSI's mandate and the AHCA's mandate are dissimilar. That would take some contortions!