Joining the ranks of 25 other states (including Montana, Texas, Louisiana, and Florida), Georgia has yet to setup an online insurance marketplace for small businesses and uninsured individuals. The Affordable Care Act (“Act”), passed in 2010, requires that health insurance exchanges be operational in the states by 2014. Governor Deal’s spokesman cited the uncertainty over the fate of the Act, which is set to be ruled upon by the Supreme Court later this year, as a reason to wait to begin the process.
One of the most controversy parts of the Affordable Care Act is the individual mandate that requires all Americans to purchase insurance. The Supreme Court is scheduled to hear remarks on March 25, with a final decision expected in June. This has been a very divisive and partisan issue for the country. For my part, though, I believe a strong argument can be made for the mandate and its ability to cut healthcare costs and improve health for Georgia and the country.
In order to ensure that all Americans have access to affordable health insurance, the Affordable Care Act requires that insurers enroll all individuals who apply for coverage, most notably those that are sick or have a pre-existing condition. With this “guaranteed issue” in place, the individual mandate is a critical component to make it all work. Contrarily, if the individual mandate did not exist, individuals would wait to get coverage until they fell ill or needed care, knowing that coverage would be guaranteed for them. This practice would lead to skyrocketing premiums for everyone, as payors would charge more for all individuals to cover this new pool of high risk, unhealthy people.
This spike in premiums has been proven. Seven states have enacted pre-existing conditions laws in the past 10 years without mandatory insurance coverage and saw significant, adverse effects. For example, in New Jersey, premiums rose as much as 350% after a law that guaranteed insurance was enacted. In New York, premiums increased as much as 40% per year, and even the percentage of nonelderly New Yorkers without insurance grew by 21%. Conversely, in Massachusetts where a mandate has existed since 2006, the average premium dropped by 40% from 2006 to 2009. More details can be found at the Center for American Progress.
Access would also be hurt with no individual mandate. It is predicted by the Congressional Budget Office that, with no mandate, only half of Americans newly covered under the Affordable Care Act would pick up insurance. The think tank RAND confirmed similar findings, where they found that, without a mandate, the number of Americans to get coverage under the Act would drop to 15 million from an estimated 27 million. At the same time, government spending would double for those newly insured individuals.
Opponents of the bill bite back and argue that Congress has exceeded the powers granted to it under the Constitution’s Commerce Clause, i.e., the government could conceivably regulate any activity in the name of commerce. And while I can appreciate an argument for limited government and the restraint of power by Washington, it is hard to argue that the federal government doesn’t have a real and vested interest in health while it is paying 50% of all healthcare bills in this country.
In my opinion, good health is a fundamental component of any free and developed society and the federal government has a responsibility to its citizenship to do everything it can to promote healthier living and improve clinical care, whether that work is led by a private or public entity or both. Healthcare is not like other industries; it is in the national interests of the country to allow all citizens the right to affordable, quality medical care and thus deserves special consideration and action.
I believe we would all benefit from mandated insurance, improved access, and lower government spending, and the citizens of Georgia are no exception.