If the individual mandate is struck down, what happens next?

If the individual mandate is struck down, what happens next?The following column was published on June 17th, 2012 in the New York Times’ Room for Debate blog.

In this election year, the Supreme Court’s judgment on the Affordable Care Act will be interpreted through a political lens. But the decision will have real-life consequences on patients, whose voice won’t be heard through the ensuing partisan din.

If the individual mandate is struck down, health insurers cannot feasibly offer insurance to all patients unless they charge patients with pre-existing medical conditions significantly more than healthy patients. According to the Congressional Budget Office, the number of Americans remaining uninsured would be 40 percent higher — 16 million people — without the mandate than with it, and insurance premiums would be 15 percent to 20 percent more.

If the rest of the Affordable Care Act stands, coverage would still expand for 17 million Americans, mostly through an expansion of Medicaid.

If health reform is struck down in its entirety, however, not only would the uninsured lose, so would other constituents with health insurance, like the elderly. One of the unsung benefits of the Affordable Care Act is Medicare’s Annual Well Visit exam, which has been offered since 2011. Thanks to these visits, which I perform everyday in my primary care clinic, I have the opportunity to evaluate seniors for their risk of falling, screen for depression and ensure preventive services like vaccines and cancer screening are adhered to.

Furthermore, health reform has already helped seniors save money. In 2011 alone, nearly 3.6 million Medicare beneficiaries saved $2.1 billion in prescription drug costs. A total repeal of law would not only hurt the uninsured, but would deny seniors benefits they already receive.

There will be no shortage of political opinion once the Supreme Court’s decision is rendered. Striking down all or part of the Affordable Care Act likely won’t affect these politicians or commentators, who are already secure in their health benefits. Our most vulnerable patients, whose voices you won’t hear, stand to lose the most.

If the individual mandate is struck down, what happens next?Kevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://twitter.com/WindyCityMed Michael Mank

    It’s amazing how many people can lose given the different outcomes that can result. If only the mandate is struck down, there is worry over the “death spiral”. http://bit.ly/M0uSsY If the entire law is struck down, I believe the Obama administration has requested to the court to scrape the rate restrictions and the no lifetime limits provision- those with pre-existing conditions and patients that develop chronic conditions lose here. I wish I had the link that states this. Regardless, many different populations of patients stand to lose depending on the decision. If the whole law is struck down, do I have the confidence that the next team of elected officials will attack this in the form of healthcare reform instead of health insurance reform? I wish I could say yes with certainty.

  • http://twitter.com/WindyCityMed Michael Mank

    It’s amazing how many people stand to lose depending on the different outcomes that could result. If the mandate is deemed unconstitutional, but the rest of the law sticks, then many worry about the “death spiral”. Alternatively, if the mandate is struck down, I believe the Obama administration has requested to the court that rate restrictions and the provision of no lifetime limits be dropped. If this happens, those with pre-existing conditions and people that develop chronic, costly conditions will lose. Regardless, different populations are on the cutting block depending on how the high justices view the ACA. If the entire law is struck down, do I have the confidence that the next group of elected officials will attack healthcare with actual HEALTHCARE reform in mind instead of insurance reform? I wish I could confidently say yes.