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Over 20 states have now joined a lawsuit to overturn the Affordable Care Act (ACA). At issue is a provision that mandates that every American carry some sort of health insurance, and for those that do not qualify for government sponsored insurance (Medicare, Medicaide, etc.), these individuals will be mandated to purchase it, hence the "individual mandate."

Opponents claim that the individual mandate is unconstitutional, and to be honest, I don't have the knowledge to no if it is or isn't. Below you'll find a list of those that sponsored a bill in 1993 that required all Americans to have health insurance, a few of whom are yelling the loudest today.

What I think is important is to understand why the individual mandate is part of the ACA.

Insurance is a way in which a group can distribute the costs incurred by a very few members over the group as a whole. While the price to join the group can vary, in order to work properly (and in the case of private insurance, to show a profit), the group has to be large enough so that the costs incurred have little impact on the whole. This group, in insurance lingo, is called a pool.

The ACA is meant to provide insurance to every American. Amongst other provisions in the law are two items that Mainers are already familiar with: the ACA no longer allows insurers to deny coverage to an individual because of a pre-existing condition, and it bans the practice of rescission, in which insurers cancel the coverage of individuals when they file a claim, again citing a pre-existing condition.

If an individual cannot be denied coverage because of a pre-existing condition, there is little incentive for healthy people to buy coverage. Instead of spending hundreds of dollars a month on health insurance that they do not use, why not wait to purchase it until such time as it's actually needed - like right after being diagnosed with cancer or becoming severely injured in a accident? From the individual's standpoint, this makes financial sense, even if there is some small fine for not purchasing insurance (which is part of the ACA).

But if a large number of healthy people did this, the coverage pool would only include members making claims, and so not distributing these incurred charges over a large group. And so the price to join the group, i.e. purchase coverage, will rise, and rise dramatically.

This has been the most significant problem with the ACA since its inception, and why the much more simple and elegant alternative, the Medicare for All Act (H.r. 676), would have been so much better to enact. There is no question that the Federal government has constitutional powers to tax Americans, and it would have provided health insurance to all Americans that wanted to use it, with no penalty to those that opted out.

Instead, we now see a constitutional challenge to the ACA that might remove only the individual mandate, leaving in place the rest of the law that is laudable. But removing the mandate will drive costs so high as to sour everyone on health care reform for another 20 years.

IT IS IMPORTANT to remember that the individual mandate began as a Republican idea, and can be found in the Health Equity and Access Reform Today Act of 1993 (S. 1770). The mandate is here:

Subtitle F--Universal Coverage

(a) IN GENERAL- Effective January 1, 2005, each individual who is a citizen or lawful permanent resident of the United States shall be covered under--

 (1) a qualified health plan, or

 (2) an equivalent health care program (as defined in section 1601(7)).

(b) EXCEPTION- Subsection (a) shall not apply in the case of an individual who is opposed for religious reasons to health plan coverage, including an individual who declines health plan coverage due to a reliance on healing using spiritual means through prayer alone.

The bill was introduced by John Chafee [R-RI] and had 20 cosponsors:

Robert Bennett [R-UT]
Christopher Bond [R-MO]
David Boren [D-OK]
William Cohen [R-ME]
John Danforth [R-MO]
Robert Dole [R-KS]
Pete Domenici [R-NM]
David Durenberger [R-MN]
Duncan Faircloth [R-NC]
Slade Gorton [R-WA]
Charles Grassley [R-IA]
Orrin Hatch [R-UT]
Mark Hatfield [R-OR]
Nancy Kassebaum [R-KS]
Robert Kerrey [D-NE]
Richard Lugar [R-IN]
Alan Simpson [R-WY]
Arlen Specter [R-PA]
Ted Stevens [R-AK]
John Warner [R-VA]
George Brown [R-CO]

As I noted, a few of these senators are still in office, and it will be fun to read exactly what they have to say about the individual mandate today. Please post anything you come across in the comments.

Originally posted to Dirigo Blue on Mon Dec 13, 2010 at 11:02 AM PST.

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