It’s been a week now since a Federal Appeals Court ruled that the individual mandate portion of the PPACA is unconstitutional. At the same time, they threw out a lower court’s ruling that would have invalidated the entire health care reform law. However, my opinion (and that of many others who are familiar with the health insurance industry) is that without the individual mandate, there is little chance of success for the rest of the law. Without a mandate, guaranteed issue health insurance is affordable only for the wealthy. Yes, the PPACA calls for subsidies to help people pay for health insurance, but we’ve been reminded quite often recently that the government does not have an unlimited supply of money.
We all know that the PPACA is headed for the Supreme Court eventually, for a final ruling. I agree with this editorial in hoping that the ultimate legal showdown happens sooner rather than later. If the Supreme Court finds the entire law to be Constitutional, then we can continue on course with states working on their health insurance exchanges and businesses sitting down with their accountants and attorneys to determine how to maximize profits and also comply with the new regulations.
If the Supreme Court tosses out the entire law, then we’re back to the drawing board. But if that’s going to be the case, it makes sense to do it as quickly as possible. States – like Colorado – that are putting money and time into creating exchanges deserve to know that their efforts are not going to be wasted. Health insurance carriers who have revamped their policies to comply with the initial changes created by the PPACA need to be able to accurately plan for the future from a logistical and financial standpoint.
And finally, if the Supreme Court is going to hand down a ruling like the one we got from the Appeals Court last week, we need to know that as soon as possible too. If the individual mandate does indeed end up being tossed out, the health care reform law will need an awful lot of compromises and revisions in order to make it tenable. Perhaps I’m being overly pessimistic, but given the level of compromise we’ve seen from the political system over the last decade or so, I have a hard time seeing how the PPACA could go on with one of its major provisions deleted. The individual mandate and the guaranteed issue portion of the law go hand-in-hand. If we strike down the individual mandate, I can’t see a way to have all policies be guaranteed issue. Doing so would mean that premiums would skyrocket or health insurance carriers would go out of business. So then we end up in a situation where we do away with both the individual mandate and the provision that would have all policies be guaranteed issue starting in 2014. Where does that leave us? Basically, back at the drawing board. We haven’t exactly been a nation at its best during the health care discourse). The individual mandate and guaranteed issue are both major departures from the way things work now. Both would help to greatly increase the number of people with health insurance, but neither can realistically stand alone.
It’s been over a year since the PPACA was signed into law. Many Americans are eagerly awaiting 2014 when their health conditions will no longer limit them to high risk pools and when their health insurance premiums will be subsidized. Health insurance carriers have already made numerous changes to comply with the law, with many more planned for the next few years. A lot of states are working hard to come up with health insurance exchanges that will best serve their residents’ particular needs. Many other states have mounted costly legal battles against the individual mandate. Some states – like Colorado – have done both. In a nutshell, an awful lot of money and time is being expended on a law that still has a very uncertain legal future.
Like most Americans, I have mixed opinions of the health care reform law. But one way or the other, I’d like to see the issue settled by the Supreme Court as soon as possible. People, states, and health insurance carriers need to be able to plan for the future with at least some certainty that the basic framework (whether it’s the current law or something new) is set in stone rather than drawn on shifting sands.