The Christian Science Monitor takes a simple stab at this question here.
But here’s a key thing to remember: There is a simple concept at the center of this rambling, Rube Goldbergian machine. Democratic healthcare reform would expand insurance coverage in America by requiring people to obtain it.
That’s right. The healthcare reform bill would mandate that most US citizens and legal residents purchase “minimal essential coverage” for themselves and their dependents. They can get this either through their employer, or, if their employer doesn’t offer health insurance, they can buy it through new marketplaces that will sell policies to individuals.
Those marketplaces would be called “exchanges.” We’ll talk more about them in a later story. (We’ll also cover subsidies for health insurance, when it all would take effect, how it would be paid for, and what it means for businesses.)
I feel sure that the requirement to purchase health insurance will be challenged in court. Forcing a purchase with the penalty of fines seems to compel associations which could give rise to constitutional challenges. The forced purchases, however, are key to the provision which is attractive to most people: elimination of pre-existing conditions as a reason to refuse coverage.
Why is Congress doing this? It’s a pretty obvious way to expand coverage, for one thing. Also, it will help bring in a flood of new customers for health insurance firms, including healthy young people who might not need much healthcare.
For insurance firms, those new customers could balance out the losses they might incur if they can no longer deny coverage to people with preexisting conditions. (Yes, that’s another change the bill makes.)
And remember, many people will not be buying this coverage purely on their own. Uncle Sam will be helping them. The bookend to the individual mandate is federal subsidies for insurance purchases, which reach deep into the middle class. We’ll talk about those next.
In essence, you and I (via taxes) will be providing coverage for people who may not want it so that people who need coverage for serious conditions will have it. Insurers may still benefit by virtue of the millions of new subscribers. I suspect there will be severe fines for insurers who attempt to limit coverage or benefits. But I don’t know. And the lack of knowledge is what is politically troubling. There will be legislators who approve this bill over the weekend that have not read it.
According to the NY Times, key votes are still in play approaching a Sunday vote.
11 thoughts on “Health care reform: Who must buy insurance?”
Obama’s letter (bold in original):
I know the press generally refers to the “individual mandate” as a “requirement” that everyone buy health insurance. And, you’re right that, phrased that way, it sounds like a stretch of Congressional power. Legally speaking, however, it’s not actually a “requirement” or a “forced purchase.” It’s a tax that one can be exempted from if one purchases a qualified health insurance plan. To us, as individuals, that legal technicality might not make much difference. Constitutionally, however, since Congress’s taxing (and exempting) power is long-established, it makes it easier to see how the mandate could be upheld.
In addition, to the extent mandatory health insurance is similar to the requirement that we all “buy in” to the Social Security system through mandatory payroll taxes, or similar to the mandatory unemployment insurance that employers must pay for, it is also likely to be upheld. Social Security and mandatory unemployment insurance were radical in their time, but when challenged, were upheld by the Supreme Court under the “necessary and proper” clause in decisions that have stood relatively unchallenged since then:
Helvering v. Davis, 301 U.S. 619 (1937) http://supreme.justia.com/us/301/619/case.html
There are good legal arguments by top constitutional scholars on both sides, though:
Health insurance – helath care. No health insurance – no health care – good, bad or otherwise.
as a parent who has one daughter graduating from college and will be ineligible to stay on our plan after graduation and who as yet has no employment prospect, i am excited about the extension that might be made for her to stay on our insuance plan til 26.
also as a parent of a daughter of 25 who could not afford $400/month payments for health insurance and went uninsured, before she went back to get her masters i am excited.
now she is turning 26 and will be uninsured again unless she can find a job with insurance during this down economic times. she has had many health issues this past year so i am excited about her being able to get insurance on her own if she needs too even with the preexisting condition.
BUT, this daughter has been abroad this school year and i have seen the kind of care available to her as she struggled with her health and attempted to get answers. in one afternoon she visited 5 hospitals before she found one that had an ENT at the hospital that day.
we ended up flying her back to the states for $750 dollars and within a week got multiple tests run that would have never happened or taken forever to happen in europe due to their health care system.
so i am very skeptical of “the government being responsible for my healthcare”.
Tos see so many think that we not help the poor and oppressed (instead they call these people lazy and looking for a hand out) and twisiting the biblical commands is just wierd.
You know, it is just so bizarre to see Americans twisting themselves up in weirder and weirder ideological knots over this health care bill, as the rest of the civilised world watches on with dismay. Generations ago the rest of the developed world realised that just as governments had a responsibility for the education of its citizens, so it also had a responsibility for the health care of its citizens. And to see so many morons via Fox News et al try to cast this as the next step toward Nazism or communism, or a betrayal of Jesus message of çapaitalism and user pays, is for so much of the rest of the world truly a thoroughly uncivilised display.
Democracy may have properly begun in the USA, but it has certainly not perfected it, that’s for sure!
I am in the same boat, Mary. The insurance I had was good, but they priced me out of it. The cost added up to everything I make of my crops in a year… if I am lucky. So I had to quit that insurance and then I had two conditions that precluded me from getting any other insurance. It wasn’t that they would not cover those conditions, they wouldn’t cover anyone with those conditions for anything else. Then I got MRSA and that added up to 3 different deal breakers with health insurance.
I’m wondering if there will be a lifetime cap on what anyone might pay out of pocket, if so and it is retroactive, I might already hit such a cap.
I wonder how much we are already paying in taxes to cover those people who are uninsured and utilizing emergency services?
On the other hand, someone like myself, with a pre-existing condition will now be able to get some insurance and not be bumped off for another health concern later on down the line because of the current one.
It is going to pass. My congressman, who is now running for the Senate seat that Birch Bayh is vacating, has decided to vote for it. If he is voting for it, under that situation, it must almost be a done-deal that it will pass.
There is a somewhat analogous point of law in agriculture with federally-subsidized crop insurance. If you want to purchase crop insurance – and you know certain plots of land are more prone to crop losses – then you cannot just insure just those suspect plots, you must insure all land that you farm. Land isn’t exactly people and you need not buy crop insurance… but?
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