The tax we all pay is the high cost of the uninsured
Once again, the U.S. House of Representatives has voted for a repeal of the Patient Protection and Affordable Care Act. Once again, the bill is going nowhere, given the lack of votes in the Senate and a certain veto by the president. And once again we ask: If the mantra is still “repeal and replace,” what would a proposed replacement look like—specifically?
More than 30 times since the current Congress was seated in 2011, the House has voted to defund, dismember or fully repeal the reform law. Federal budgets approved in the House to date also have zeroed-out the ACA.
One of the latest attack lines against the law—fueled by the reasoning the U.S. Supreme Court employed to uphold the constitutionality of the statute—targets what opponents are calling a “massive tax increase” imposed by the individual mandate, which beginning in 2014 requires one to acquire health insurance or pay a penalty.
The justices in their decision last month declared the mandate mechanism a tax. The Obama administration contends it’s a penalty. Whichever word one wants to use doesn’t change the scope or mission of the mandate, which as this page has mentioned numerous times is a conservative idea that Mitt Romney wholeheartedly embraced as a linchpin of the healthcare reform model he enacted as governor of Massachusetts. If the presumptive GOP presidential nominee prefers to call the ACA’s mandate a tax, then he can’t legitimately escape calling the same approach in Massachusetts a tax.
That semantics fight is a sideshow. What needs to become a larger part of the debate—more so than any tax aspect of the individual mandate, which will affect only a small percentage of the population—is the truly massive hidden tax that has been imposed on employers, payers and patients for a long, long time. It’s the cost of healthcare services passed along throughout the system in the form of higher premiums resulting from care for the uninsured.
A significant portion of those costs comes from our fellow citizens with the means to buy health insurance coverage but who—for whatever reason—opt not to do so. Often it’s the young and healthy, seeing themselves as seemingly invincible, who just don’t see the need for coverage, maybe trying to prove their self-reliance.
Unfortunately, the young do get sick. They can get very sick, resulting in drawn-out hospital stays. Tragic accidents occur all the time, with devastating injuries usually resulting in a long road to rehabilitation. These scenarios can and do result in millions of dollars in care in very short order. When family resources run out, what’s the recourse? Those costs get picked up and passed along somehow, whether it’s through government programs or provider write-offs.
Other times, the lack of insurance is because of circumstances beyond one’s control. The resulting inadequate access to care imposes another insidious tax on our system. When the uninsured and underinsured are forced to forgo basic care and routine screenings, care delayed can easily result in cascading costs in the long term. And we all pay the price for that.
If not the individual mandate, let’s hear some alternatives on how to share the insurance risk more equitably. And does any replacement for the ACA just give up on the goal of access to healthcare for all?
Last week’s House vote against the ACA probably won’t be the last in that chamber this year, but any others will again be mostly symbolic. The only votes that will truly count are the ones that will be cast less than four months from now on Nov. 6.
DAVID MAY Assistant Managing