Health Insurance Mandates

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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  • don

    If mandatory health insurance is such a great idea, why are several million supporters of Obamacare requesting waivers? Seems that they want the care but not the bill. I would like a new car every year and a million dollar house to live in. I don’t want to pay for it. Can we get Obama to pass a law for that too?

  • Jane

    Hospitals are required to treat every patient regardless of their ability to pay.
    As long as the public is forced to pay for those who are uninsured, I believe everyone should have health insurance.
    Otherwise the current situation of uninsured people cramming into the emergency room and bankrupting hospitals and health services will be unending.
    It’s only fair for all to pay for the service they receive. Otherwise we need to allow hospitals to refuse service to the uninsured.

  • Chris

    While people are trying to say that they don’t want to PAY for the uninsured, we all have to remember that we could ALL be there someday! If insurance companies refuse or deny care connected to your diabetes. Or if you get so sick you can’t work…lose your insurance, home, income…then what do you do? Let the hospitals kick you out and let you die? It’s happened! Hospitals will initially do triage type assessment and slap on a bandage, but that’s about it. Then out the door you go! So all these people who are against Universal, Single-Payer Healthcare BEWARE! YOU may be there some day and I bet your bottom dollar that very few would come to your aid with the hundreds of thousand dollars it would take to pay your hospital and medical bills. While you may now be “assisting” to pay for some uninsured, they then or others may then be paying for YOU! No amount of savings or 401K’s will last forever…people with catastrophic illnesses have burned through those in no time.

  • Dennis Miller

    Why are a lot of people(1/3 are unions, the Obama supporters) requesting waivers? Could it be that costs would prohibitively rise? The American people were handed a bill for goods from a snake oil con man. The Constitution doesn’t mention healthcare, so the Federal Gov. can not regulate it. This is just another way of taking our freedoms from us. Regarding Jane’s post, when she said that everyone is paying for the uninsured so we should be forced to having Obamacare(paraphrasing). We would all be paying for everyones healthcare, that is except those that got waivers. It’s just a bad idea from the get go.

  • Eric

    If we want to keep quality healthcare available to the most people possible, we need to keep the government out of mandating it and restore as much patient control to the process as possible. To use healthcare for routine medical such as annual checkups and dental cleanings, fillings etc, automatically adds 15 to 20 percent in handling costs. Individuals should budget and pay those expenses directly or using a Health Savings Account to minimize administrative overhead. Use healthcare coverage to cover major medical and catastrophic care. If the government prohibited denial based on pre-existing conditions for individuals who had continually maintained some kind of catastrophic care, the risk factors for that can easily and economically be factored into healthcare costs. What cannot be factored in are people who go without coverage until they are sick and then expect everyone else to pay for them–and the more our society has subsidized that behavior, the more of it we are getting and it will bankrupt the system. We msut restore responsibilty to individuals and families if we want to go forward with the best possible healthcare–and those of us on diabetes have more at stake than most.

  • Jack

    Whey is the entire state of Nevada exempt from Obama Care? Whey are people of the Muslim faith exempt? Why are Government employees exempt? What does a 3% tax on capital gains from real estate sales after 2012 have to do with health care? Why is that in the bill. Lets start over and do it right. Why is the cost of Medicare going to double by 2014 if Obama Care is going to reduce the cost of health care?

  • Alan Elkins

    I think that nobody should have to buy anything they can’t afford or need. The goverment should worry about more issues like, the economy and jobs and not try to run peoples lives.