Mandate purchase of health insurance

In 2010, Congress passed the Patient Protection and Affordable Care Act. It has since faced legal challenges, including a call for revocation of the entire law. The U.S. Supreme Court will hear arguments on the law.

In the public discourse, we often hear that the mandate to purchase insurance is unconstitutional. We rarely hear of the law's other provisions, including giving access to insurance for people with pre-existing conditions, allowing young adults to stay on their parents' insurance until the age of 26 and providing small businesses tax credits to help provide insurance for workers.

Some believe health care policy is the purview of the states, not the federal government. But when will the state act? In sight of Utah's legislative leaders, the rolls of the state's uninsured have grown to more than 300,000. Practices of insurance companies — such as denying people with pre-existing conditions — are a nationwide problem. Applying the weight of the federal government can compel companies to change and has made them change. Further, under the commerce clause of the U.S. Constitution, Congress has the power to regulate interstate commerce. Of the top 10 health insurance companies in Utah, according to market share, most are headquartered outside the state. The number one company, Regence Blue Cross Blue Shield, also operates in Idaho, Oregon and Washington. Payments for health care in Utah cross state lines.

Those opposed to the mandate state that the law exceeds the bounds of the commerce clause by regulating "economic inactivity" — a person's decision not to buy health insurance. However, many people without insurance are using health care services.

President Ronald Reagan signed into law the Emergency Medical Treatment and Labor Act which requires health care providers to give emergency care to everyone in need regardless of ability to pay. An ER physician informed me that uncompensated ER costs are often shifted to individuals with insurance.

In 2008, the Kaiser Family Foundation estimated the annual cost of all uncompensated health care at $56 billion annually, 75 percent of which gets billed to taxpayers, while the consumer group Families USA reported in 2009 that uncompensated care raises the average family insurance premium by $1,017 annually.

A mandate could reduce individual and employer insurance costs through broadening the risk pool and enforce provisions through eliminating insurers' excuse of adverse selection.