Diabetes Self-Management Blog

The health insurance reform act signed into law last year by President Obama — known as the Patient Protection and Affordable Care Act — contains provisions that may be especially relevant to people with diabetes, including greater funding for preventive health efforts and the prohibition of denying insurance coverage to people with preexisting medical conditions. These aspects of the law are relatively uncontroversial, although the provision on preexisting conditions is related to one that has sparked intense disagreement: To prevent healthy individuals from simply waiting until they get sick to buy insurance (since rejecting their applications will no longer be allowed), the act mandates that nearly all Americans obtain health insurance coverage starting in 2014.

Proponents of the health insurance mandate claim, furthermore, that by expanding the health insurance pool to include more healthy people, the cost of insurance will go down. And to help make buying insurance affordable for everyone, the law offers subsidies based on income level. Opponents of the individual mandate tend to have a philosophical objection: that the government is forcing individuals to buy a product. This, many claim, is unprecedented in American history and does not fall within the scope of Congress. Based on this assertion, many different parties have sued against the individual mandate in federal court. Last week, two of those cases reached the Court of Appeals for the Fourth Circuit in Richmond, Virginia — only one rung below the US Supeme Court.

According to a Reuters article on the hearing, which happened last Tuesday, the two lawyers challenging the law — Duncan Getchell, solicitor general of Virginia; and Mathew Staver, dean of the law school at Liberty University — argued that “inactive bystanders” were being forced into the insurance market, and that Congress has the power to regulate only economic activity, not inactivity. Neal Katyal, the acting US solicitor general, countered that everyone requires access at some point to health care services, often in a manner they cannot predict; thus, the law simply regulates when and how they pay for those services. The article also notes that on the same day as the court hearing, the US Department of Health and Human Services released a report showing that more than 50 million people in the United States lack health insurance, and that almost 2 million of the uninsured are hospitalized each year.

What do you think — given the unpredictability of medical needs, should individuals be required to have health insurance? If so, should there be exemptions for people with strong philosophical or religious objections — or should these people have to pay the normal penalty under the law? Is there a difference, in principle, between the government mandating and subsidizing health insurance coverage, and providing it directly — as it does through Medicare and Medicaid? Leave a comment below!

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Flashpoints
Chocolate to Fight Diabetes? (12/17/14)
Metformin for All? (12/10/14)
An Aspirin a Day? (12/03/14)
Bills and Empty Pockets (11/26/14)

 

 

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