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Court weighs making health coverage a fact of life

By Connie Cass

Associated Press

Published: Friday, March 23 2012 5:45 p.m. MDT

FILE - In this Feb. 22, 2012, file photo Republican presidential candidates, former Massachusetts Gov. Mitt Romney, right, and former Pennsylvania Sen. Rick Santorum, argue a point during a Republican presidential debate in Mesa, Ariz, during which Santorum confronted Romney about "Obamacare". All four GOP candidates now promise to repeal “Obamacare,” with Santorum calling it “the death knell for freedom.” Its model was a Massachusetts law signed by frontrunner Romney, when he was governor.

Jae C. Hong, File, Associated Press

WASHINGTON — Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no.

People are split over the wisdom of President Barack Obama's health care overhaul, but they are nearly united against its requirement that everybody have insurance. The mandate is intensely unpopular even though more than 8 in 10 people in the United States already are covered by workplace plans or government programs such as Medicare. When the insurance obligation kicks in, not even two years from now, most people won't need to worry or buy anything new.

Nonetheless, Americans don't like being told how to spend their money, not even if it would help solve the problem of the nation's more than 50 million uninsured.

Can the government really tell us what to buy?

Federal judges have come down on both sides of the question, leaving it to the Supreme Court to sort out. The justices are allotting an unusually long period, six hours over three days, beginning March 26, to hear arguments challenging the law's constitutionality.

Their ruling, expected in June, is shaping up as a historic moment in the century-long quest by reformers to provide affordable health care for all.

Many critics and supporters alike see the insurance requirement as the linchpin of Obama's health care law: Take away the mandate and the wheels fall off.

Politically it was a wobbly construction from the start. It seems half of Washington has flip-flopped over mandating insurance.

One critic dismissed the idea this way: "If things were that easy, I could mandate everybody to buy a house and that would solve the problem of homelessness." That was Obama as a presidential candidate, who was against health insurance mandates before he was for them.

Once elected, Obama decided a mandate could work as part of a plan that helps keep premiums down and assists those who can't afford them.

To hear Republicans rail against this attack on personal freedom, you'd never know the idea came from them.

Its model was a Massachusetts law signed in 2006 by Mitt Romney, now the front-runner of the Republican presidential race, when he was governor. Another GOP hopeful, former House Speaker Newt Gingrich, supported a mandate on individuals as an alternative to President Bill Clinton's health care proposal, which put the burden on employers.

All four GOP presidential candidates now promise to repeal the Affordable Care Act, which they call "Obamacare." Former Pennsylvania Sen. Rick Santorum calls it "the death knell for freedom."

So much for compromise.

Obama and congressional Democrats pushed the mandate through in 2010, without Republican support, in hopes of creating a fair system that ensures everyone, rich or poor, young or old, can get the health care they need. Other economically advanced countries have done it.

Doing nothing is more expensive than most people realize.

Congress found that when the uninsured go to clinics and emergency rooms, the care they can't pay for costs nearly $75 billion a year. Much of that cost is passed along and ends up adding $1,000 a year to the average family's insurance premium.

The overhaul is neither the liberal dream of a single government program supported by taxes and covering everyone nor the conservative vision of stripping away federal rules and putting free enterprise in charge.

The Obama plan relies on private companies plus lots of regulation to make sure they provide basic benefits, keep premiums reasonable, and cover the sick as well as the healthy. That's where the mandate comes in. If insurers must cover everyone, even those with existing medical conditions, healthy people have little incentive to sign up before they get sick.

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