individual mandate


Lingering Health Law Questions Jon Stewart Wants Answered

By Georgia Feuer
Guest Contributor

Last week Jon Stewart hosted Secretary of Health and Human Services Kathleen Sebelius on The Daily Show. During the interview, he kept returning to the same question: Why was the piece of the Affordable Care Act that requires businesses to provide health insurance delayed for one year, but the piece requiring individuals to obtain health insurance (the “individual mandate”) was not delayed?

In her answer, Sebelius mentioned that there are subsidies and tax credits available to individuals starting in 2014 and also that the so-called “employer mandate” affects a very small number of businesses. The employer mandate only applies to businesses with 50 or more employees. Only 5% of businesses have 50 or more employees, and most of these companies already offer insurance.

Screen shot 2013-10-14 at 1.11.38 PMBut Jon Stewart was not satisfied with her answer, and that is because she did not give the whole answer. The real reason why the individual mandate cannot be delayed is that it is too crucial to the success of health care reform. To understand why, let’s suppose that getting health insurance was, in fact, voluntary. Then the people who would be most motivated to purchase health insurance are those who are sick. Continue reading

Health Law Deja Vu: Bush v. Gore And Politics On The High Court

Lady Justice (Scott*/Flickr)

Lady Justice (Scott*/Flickr)

In the fall of 2000, my reporter buddies and I would gather every evening at various bars or people’s apartments, fixated and anguished by the political theatre of Bush v. Gore before the U.S. Supreme Court. Yesterday’s partisan grilling by the justices on the health law’s individual mandate slammed me right back to that time. Once again, politics seemed to dominate the high court in so many ways.

As I followed all the analysis yesterday — CNN’s Jeffrey Toobin says the mandate is dead, the government’s case is deemed a “train wreck,” the anti-health-law faction’s broccoli-obsession, etc. — I wondered if the justices truly came at the case with open minds or if political orientation is the main driver here. We may never know. But if you want comprehensive coverage of the drama that continues today with arguments on Medicaid and “severability,” here’s Kaiser Health News’ Health Law March Madness, which examines pretty much every angle of the case and its broad implications.

Here’s one piece looking at ways to salvage the health law should the individual mandate be found unconstitutional:

There are ways that Obama—if he’s re-elected — might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say.

These fixes would create financial incentives for people to not delay enrolling in insurance. Continue reading

Why Historic SCOTUS Case Doesn’t Really Matter For Massachusetts

The health care battle that begins this morning at the U.S. Supreme Court is one of the most important of our lifetime. But the direct effect on Massachusetts, which created the framework for the federal Affordable Care Act (ACA), is minimal, at best.

“The real bottom line is that consequences for Massachusetts are not that great, except the extent to which we care about the uninsured in the rest of the country,” says Harvard School of Public Health professor John McDonough.

Here are the main issues before the high court as they pertain to the Commonwealth:

1) The Individual Mandate — The question for the high court is whether the requirement that residents have health insurance is constitutional. But either way, it is already part of state law in Massachusetts and would stand regardless of what the Supreme Court decides. A related provision, that says residents can’t be denied insurance if they have a pre-existing condition, is also already in state law.

2) Can the ACA stand without the Individual Mandate? – Again, this doesn’t matter for Massachusetts. Harvard Law School professor Lawrence Tribe says: “There are no legal issues before the Court in which a decision would either trump the Massachusetts law or compel a review of that law.” Continue reading

Politico: Obama Targeting Supreme Court Conservatives On Health Law

The U.S. Supreme Court considers the health law this month. (OZinOH/flickr)

This month, the U.S. Supreme Court is scheduled to hear arguments on the constitutionality of the Affordable Care Act, the national health law signed by President Obama in 2010.

Politico reports on the administration’s strategy targeting conservative justices on the high court, hoping that at least one of them will rule in favor of the law. Here’s a run-down of the government’s approach, including a play for Scalia:

Administration lawyers have peppered their briefs with citations to opinions written by Anthony Kennedy and Antonin Scalia, they’ve seized on the arguments made by one of Scalia’s most beloved former clerks and their allies in legal circles have talked up how a decision upholding the Affordable Care Act would play into John Roberts’s legacy as chief justice.

A long shot? Maybe, but it’s the only shot the administration has on a court dominated 5-4 by conservatives… Continue reading

Ballot Campaign to Repeal Insurance Mandate Ends In Mass.

From the Massachusetts Against the Mandate Webpage

By Martha Bebinger

If you chafe against the Massachusetts requirement that you have health insurance, sorry but you won’t have a chance to vote against it — not in the next election, anyway.

Backers of a ballot measure to repeal the state’s insurance mandate sent out an email last week saying they had failed to gather the needed signatures. (Points to policy-types-turned-crack-reporters Brian Rosman of Health Care for All and John McDonough of Harvard for reporting that development here and here.)

The ballot initiative’s organizers say their bid to derail the individual mandate failed because supporters were torn.

One group, those involved with Massachusetts Citizens for Life, worried about dividing their efforts between two ballot questions next year, one that would allow assisted suicide and one that would repeal the insurance mandate. In the end, fighting the assisted suicide question won.

In addition, conservative backers “were very concerned that this would make Mitt Romney look bad, and as they support him in the primaries they didn’t want to sign on to this, or donate to it or work for it” says Bridget Fay with Massachusetts Against the Individual Mandate. Continue reading

Couple’s Penalty For Shoddy Health Coverage Resonates Nationally

Prediction: The name Destito is going to be bandied about in national politics. I can even imagine an attack ad against ObamaCare: “Do you want to become a Destito?”

Boston Herald columnist Margery Eagan listened in on the Destitos’ appeal hearing with the state Connector, the agency that helps Massachusetts residents shop for and obtain health insurance, and describes it in the Herald here. She writes that the Plainville couple, both 50 and already bankrupt, face a $3,000 fine because the shoddy health insurance they bought after their business folded “apparently does not pass muster with the state’s mandatory universal health insurance law.”

Do I hear the conservative talk show hosts clearing their throats? Already, Newt Gingrich wielded the Herald report against Mitt Romney in the Oct. 18 Republican presidential debate. The Destitos’ case touches on the third rail of health reform politics: the “individual mandate” that requires virtually everyone to have health insurance or pay a penalty, for reasons of both equity and economics. it’s the hottest-button issue in national health reform, and faces major legal challenges. Posted yesterday, the Herald column has already garnered over 140 comments, including this from MuffinMom: “They had health inurance and the state says it wasn’t enough and is fining them???? Beyond the pale!”

‘An avenue for individuals to come tell their stories to a human being’

But before the Destito case goes national, here’s some important context from the Connector: State law does require that health insurance fulfill some minimal coverage levels to count under the mandate, but residents who face fines have ample rights to appeal the fines and explain their economic straits, and their appeals win more often than not.

Connector chief Glen Shor

Glen Shor, chief of the Connector, emphasizes that the appeals process is, very deliberately, a “point of flexibility” in the system, meant to ensure that penalties imposed under the individual mandate “in any given instance are not solely a function of rules on paper doing their thing. Rather, the appeals process creates an avenue for individuals to come tell their stories to a human being, encompassing all the relevant details of their individual lives.” Continue reading

Handicapping The Health Law’s Odds Before The Supreme Court

Will The Supremes Kill The Health Law?

Stuart Taylor, writing for Kaiser Health News, offers an authoritative analysis of what will happen when (and everyone seems to agree it’s only a matter of time) the national health law goes before the U.S. Supreme Court. The bottom line: Taylor put the odds at “about 25 percent to 33 percent” that the centerpiece of the law, the individual health insurance mandate, is overturned. (He says the court is even less likely to toss out the rest of the law).

Here’s how he got there:

For starters, the court’s four Democratic appointees seem almost certain to vote to uphold the law. And Justice Clarence Thomas seems almost certain to vote to strike it down. Still, it’s harder to call the other four Republican appointees, Chief Justice John Roberts and Justices Antonin Scalia, Anthony Kennedy and Samuel Alito. Each side in the health care litigation has cited one or more opinions written or signed by each of these four justices. But even on the questionable assumption that each is a good bet to vote with Thomas, the odds seem against all four doing so. (For example: 2/3 x 2/3 x 2/3 x 2/3 = 16/81.)

Explaining why he’s betting the high court will uphold the law, Stuart, a contributing editor for National Journal, concludes this way:

And in this case, the justices may turn to an important principle: When the constitutional arguments for and against striking down a major act of Congress seem almost equally strong, say advocates of judicial restraint, the court should defer to the people’s elected representatives — no matter how unpopular they are with the people.

“Time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of this national legislation,” as Judge Sutton concluded, “allowing the people’s political representatives, rather than their judges, to have the primary say over its utility.”

Anti-Abortion Group Seeks Ballot Measure On MA Health Insurance Mandate

Do you chafe against the Massachusetts requirement that you have health insurance? You may soon have a chance to vote on it.

This just in from Kyle Cheney at the State House News Service: The anti-abortion group Massachusetts Citizens for Life plans a press conference tomorrow on its launch of a ballot measure seeking to repeal the requirement that virtually all residents have health insurance. He writes:

Massachusetts Citizens for Life, an anti-abortion organization, intends to initiate a ballot petition that would repeal the requirement that all Massachusetts residents obtain health insurance, a core provision of the state’s landmark 2006 health care law.

Anne Fox, president of Massachusetts Citizens for Life, told the News Service she hopes the repeal of the mandate will lead to an eventual dismantling of the entire law, which she said has lengthened the wait for doctor visits, contributed to rising insurance premiums and resulted in an increase in taxpayer-funded abortion.

“It’s a place to start,” she said of the petition effort. “We’re not saying that the individual mandate is the end. It’s the beginning.”


According to an advisory distributed by the organization Monday, MCFL intends to file 10 signatures with the office of Attorney General Martha Coakley by Tuesday to begin a repeal of “Romney-care,” a name that critics of the law have used derisively to tie it to the former governor and Republican presidential candidate. Former Gov. Mitt Romney, front-runner for the Republican nomination, has embraced the law, which he signed in his final year in office, despite criticism from within his party. Continue reading

MA Collects $65 Million In Fines From Uninsured Under Health Law

Massachusetts has collected $65 million in fines since the individual mandate, the centerpiece of the state’s 2006 health reform law, has been in place, WBUR’s Martha Bebinger reports.

The mandate was included in the health reform law to compel healthy residents, and others who didn’t have health insurance, to purchase it. As fines rose from $219 in 2007 to $1212 this year, money collected in fines dropped, which is the way the mandate was supposed to work, says Health Connector director Glen Shor.

“Everything we’ve seen about health reform in Massachusetts is that more and more people are entering into the ranks of the insured,” he said. “It’s no surprise to see penalties going down.”

The $65 million helps fund subsidized coverage for low-and moderate-income residents. Mandate opponents say this total is proof it is an unfair and unjust burden on residents who decline coverage.

Ron Norton, a longtime opponent of the mandate who is uninsured told Martha: “That’s $65 million taken out of the Massachusetts economy that could have done a lot better things. I doubt that the penalty has had much affect other than extorting people for money who could not afford to buy insurance.”

(Norton paid the penalty in 2007, 2008 and 2009. In 2010 he got a waiver because after turning 50, he fell into the category of people for whom the state says insurance is not affordable.)

Massachusetts Study: Yes, Mandates Push Healthy People Into The Insurance Pool

There’s no hotter-button issue in federal health care reform than the “individual mandate” — the government’s requirement as of 2014 that almost everyone buy health insurance, or else pay a penalty.

It is now being tested in the courts, but meanwhile, three prominent health economists — Amitabh Chandra from Harvard, Jonathan Gruber from MIT, and Robin McKnight from Wellesley — are adding some Massachusetts facts to the fire. In The New England Journal of Medicine here, they report their findings in a paper titled “The Importance of the Individual Mandate — Evidence from Massachusetts.”

The question: Is a mandate really necessary to get healthy people to buy insurance? Or might it be enough to just heavily subsidize health insurance premiums for lower-income people? (The system needs healthy people to buy insurance. If they don’t, the authors note, it’s as if car insurance were bought “only by high-risk drivers (or worse, only by drivers who have just had an accident).”)

The study looked at Massachusetts residents who joined Commonwealth Care for state-subsidized health insurance as health reform was getting under way here, first with subsidies and then with an individual mandate. It examined people whose incomes ranged from 150 to 300% of the federal poverty level, so they would have to pay a modest portion of their premiums themselves. Among those joining the state’s Commonwealth Care, how healthy were they?
The authors write:

When the mandate became fully effective at the end of 2007, there was an enormous increase in the number of healthy enrollees and a far smaller bump in the enrollment of people with chronic illness. Continue reading