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.

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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