However, the government’s numbers seem to be inflated as the authoritative Medical Expenditure Panel Survey calculates the uncompensated costs closer to $12.8 billion, or one-half of one percent of the $2.4 billion Americans spend annually on health care. In addition, under full implementation of the federal law, 30 million citizens will remain uninsured; and they account for the vast majority of the uncompensated care cost.
A closer consideration of the government’s claim demonstrates that the individual mandate has little to do with cost-shifting in healthcare markets. The fact is that the population principally targeted by the mandate (those who can afford health insurance but voluntarily choose not to purchase it) plays a minimal role in the cost shifting identified by the government.
As declared in the Affordable Care Act’s findings section, the mandate was included not to end cost-shifting, but to require millions of Americans to pay more for health insurance than they receive in benefits in order to subsidize both the voluntarily insured and the insurers, and thereby to moderate the sharp increase in insurance premiums that would otherwise be caused by the ACA itself. Claims of the uniqueness of the healthcare market don’t stand up to the realities of data. Instead, the real issues in the health care market primarily are local and therefore must be addressed accordingly.
The problems with the government’s argument in support of the law don’t end there. Much of its cost modeling is based upon supposed likenesses between the federal law and the 2006 Massachusetts health reform law. But Massachusetts accounts for just two percent of the nation’s population, and Bay Staters are wealthier and more likely to be insured than Americans as a whole.
Assuming that businesses and individuals in New Mexico and Massachusetts share similar characteristics—or are patients suffering from the same ailments—is policy malpractice. Even a quick review of differences in demographics, income levels, health infrastructure and employer commitment to offer insurance should dissuade any thinking person from such confusion.
If central parts of the health care law are struck down and President Obama and congressional leaders are forced back to the drawing board, they should take a close look at President Clinton’s handling of welfare reform during the 1990s. Clinton granted waivers that set goals for results, but provided states the flexibility to figure out how to achieve them.