The House Republican “Suicide Caucus,” which joined with Senators Ted Cruz (R-TX) and Mike Lee (R-UT) in demanding that the Affordable Care Act (ACA) be defunded as part of any deal to keep the government open, had a backup demand: delay the individual mandate.
The mandate requires that all Americans who can afford it purchase health insurance or pay a penalty that begins at $95 or 1 percent of yearly income, whichever is higher.
This aspect of the ACA was developed by conservatives as an alternative to the Clinton health care plan in the early 90s and it’s designed to end the problem of “free riders,” uninsured people who get treatment in emergency rooms with no hope of providers ever recovering the costs. The mandate provides the subscriber base insurers need to cover people with pre-existing conditions without charging them exorbitant premiums.
Delaying this aspect of the law could wound the ACA, or possibly even destroy it, before it’s ever given a chance to work. That’s why Republicans would love to see it happen.
However, the continuing problems with Healthcare.gov have given Republicans another opportunity to make the argument that the mandate should be delayed. Here are four reasons it’s not really “an option” and one nightmare scenario where it could be.
1. It will leave millions and millions of Americans without health insurance.
The Congressional Budget Office (CBO) estimates that delaying the individual mandate would leave millions uninsured. And those who did sign up for insurance would likely be sicker and thus costlier to cover. Other estimates suggest that the number of uninsured would increase by between 7.8 and 24 million.
Most of these people would be low-income Americans who are far more likely to use emergency rooms than those with insurance.
2. People will die.
A Harvard University study released in 2009 found that uninsured adults have a 40 percent higher death risk than those with private health insurance. “Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease,” David Cecere of the Cambridge Health Alliance wrote in 2009.
Media Matters‘ Hannah Groch-Begley explains the risk of not having health insurance:
Those who lack adequate insurance often “avoid going to the doctor or getting prescriptions filled because they can’t afford it,” according to Kaiser Health News, and others “end up with medical debt and other severe financial problems.” The Commonwealth Fund has found that half of the underinsured “said they had not received needed care because of cost,” and 67 percent of uninsured people “reported at least one cost-related problem getting needed care.” Emergency rooms are required by federal law to treat all individuals regardless of insurance, but the uninsured are less likely to receive follow-up care, are at higher risk for preventable hospitalizations and for missed diagnoses, and have significantly higher mortality rates than those with insurance.