Individual mandate is critical for guranteed health coverage

By Michael J. Pramenko

The wait is over. On Thursday, the Supreme Court of the United States affirmed the constitutionality of the individual mandate. Now, work can continue on health reform.

Indeed, multiple elements of the Affordable Care Act depend upon the individual mandate. Without it, receiving the right care, in the right place, at the right time becomes a near impossible task for some Americans. 

The individual mandate, present politics excluded, has enjoyed wide bipartisan support over the last 20 years. In fact, the concept enjoys support here at home. The 208 Bipartisan Commission on Colorado-based Health Reform, Club 20 and the Colorado Medical Society are just a sample of state-based organizations that support an individual mandate within health reform.

At a national level, the conservative Heritage Foundation has supported the individual mandate and Mitt Romney supported it as an essential element of his Massachusetts health reform law.

Certainly, without the individual mandate, no mechanism exists to privately insure individuals with pre-existing health conditions. In fact, a government-run health system remains the only other legitimate method to cover these unfortunate Americans.

The individual mandate is consistent with the existing societal contract that allows open access to emergency rooms across the United States. To maintain that safety net in a cost- effective fashion, we need a health system that redirects individuals away from the emergency room and toward a personal physician.  We need personal responsibility to purchase health insurance prior to the actual need for that insurance. We need better preventive care and chronic disease management to reduce the need for expensive hospitalizations.

The individual mandate allows for these critical elements of high-quality, cost-effective health care. 

It wasn’t until the individual mandate was included in President Obama’s health reform legislation that the idea became so partisan. In fact, the idea for the mandate started on the Republican side of the aisle back in the 1990s.

Currently, even while some politicians voice strong opposition to the individual mandate, they contradict themselves by supporting the concept of guaranteed issue — a concept that guarantees health coverage despite pre-existing conditions. You simply can’t have one without the other.

Just last week, Gov. Scott Walker of Wisconsin voiced support of this provision. On Thursday, the day of the ruling, Romney voiced support for guaranteed coverage of pre-existing health conditions.

This support of guaranteed issue, in the face of his opposition to the individual mandate, demonstrates a rather profound lack of understanding of health policy economics —  or extreme political maneuvering.

However, understand this concept and you will pass Health Policy Economics 101. Plus, as sad as it may be, you would have a better understanding of our health insurance problem than many politicians in this country.

Repeal and Replace? Repeal and replace with what?

Simplistic one-liners do not solve the problem of the uninsured and do not solve the problem of pre-existing conditions blocking the ability to purchase health insurance. We need to hear specific policy recommendations from Affordable Care Act opponents — especially given the fact that many are voicing support for guaranteed issue.  The voters, especially in this presidential election year, deserve clarification.

Remember, we already attempt to provide health care to everyone in this country via the emergency room. The Affordable Care Act and the individual mandate are legitimate attempts to adhere to that principle, but in a more logical and cost-effective fashion. Provide health care to Americans before they need an emergency room or a hospital.

So, in the wake of the Supreme Court decision on the individual mandate, ask yourself one question: Should Americans be able to purchase insurance even if they have a significant pre-existing health condition? If your answer to that question is “yes,”  celebrate this court decision and celebrate the improved access to health care for someone less fortunate than you.

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is the immediate past president of the Colorado Medical Society.


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