The “individual mandate” and health reform: small steps, big challenges

Here on campus, many of us have spent the past few weeks cramming. Cramming for an epidemiology final. Cramming one more get-together with friends on an impossibly full calendar. Maybe cramming one more piece of turkey onto a plate piled high with holiday food.  We missed a lot of things during these past few weeks — and I’ll try to cover some of the highlights for you in the new year — but let’s talk about one of the big ones:  the likely demise of the “individual mandate” in President Obama’s Affordable Care Act.

The individual mandate was meant to require everyone in the United States — at least, those who can afford it — to purchase a “minimally comprehensive” insurance policy. So if you don’t have insurance in place (through an employer, as many Americans do), and can afford it, you’ll pay a fine: $695 a year (per adult) or 2.5 percent of your income, whatever’s higher.  Back in March, Virginia judge Henry Hudson declared the law unconstitutional, one in a series of Republican-led demonstrations contesting what is frequently referred to as “Obamacare.”

The response to this challenge is mixed: some health care reformers (Howard Dean among them) believe the bill doesn’t need the individual mandate in order to succeed.  Others (health insurance industry advocates, for example) believe we do: that insurance providers will not be able to compete fairly and transparently without a large pool of insured Americans, both healthy and sick.

Health care providers in Massachusetts would likely argue the latter. Their state’s mandate, enacted by a Republican governor in 2006, increased the number of insured residents to 98.1%– the highest rate of insured in the United States, according to a new report from the state’s Department of  Health and Human Services. This, in the midst of a serious recession wherein many Americans have lost insurance coverage.

The good news: politics can change, and quickly.  Government-sponsored health plans have been pitched before, even by staunch Republicans.  Although the individual mandate may fail, an “opt-out” option may satisfy both parties — allowing individuals to opt out of the general insurance pool, and later return. Children whose parents opt-out, meanwhile, could remain covered under existing programs. For a great explanation of the opt-out option, click here: