Friday, August 26, 2011


It looks like Healthcare Reform is heading for the Supreme Court as the most controversial component of the law, the individual mandate, has been deemed unconstitutional by the lower courts. From the moment the law was enacted I've wondered how an individual can be forced to buy health insurance. However, this mandate is absolutely necessary in order for reform to work to prevent adverse selection. Without the inclusion of healthy people in the pool of insureds the insurers will assuredly get an influx of unhealthy people and will, therefore, be in a tenuous financial situation. Now that insurers cannot deny people health insurance because of pre-existing medical conditions (for children since 10/1/10 and for all others beginning 1/1/14), sick people have access to coverage and will take the opportunity at any cost. But insurance companies must get an equal number of healthy people to balance out the number of sick people or they will be out of business, and no one wins! But can the government force an individual to buy something they do not want?

Without healthcare reform the most advantageous prohibitions will be lost such as the prohibition of pre-existing conditions exclusion; the prohibition of lifetime maximums; the elimination of annual limits for essential health benefits; the continued eligibility of children to age 26; the requirement to cover preventive services with no co-payments or co-insurance; and the requirement to treat birth control for women as preventive care with no co-payments. But, since there was no discussion about controlling the premiums the question remains--How can you force someone to buy a very expensive commodity that they do not want?

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