The Supreme Court is set to release their opinion on the constitutionality of the Accountable Care Act, more commonly known as Obamacare, in the coming days. Most high-court observers believe that the individual mandate, which requires almost everyone to buy health insurance, will be ruled unconstitutional as violating the Commerce Clause of the Constitution. However, the rest of the new healthcare law is likely to remain intact.But the individual mandate is so essential to spreading the risk and cost of health care over the whole population, including younger and healthier people, that some analysts believe a Court decision that nixes the mandate will effectively spell the end of the Act anyway.
Yet it could have exactly the opposite effect. If the Court strikes down the individual mandate, health insurance company lobbyists and executives will swarm Capitol Hill seeking to have the Act amended to remove the requirement that they insure people with pre-existing medical conditions.They’ll argue that without the mandate they can’t afford to cover pre-existing conditions, and people with pre-existing conditions will be left without insurance.
But the requirement to cover pre-existing conditions has proven to be so popular with the public that Congress will be reluctant to scrap it.
This opens the way to a political bargain in which insurers might be let off the hook, for example, only if they support allowing every American, including those with pre-existing conditions, to choose Medicare, or something very much like Medicare. In effect, what was known during the debate over the bill as the “public option.”
The individual mandate is the least popular part of Obamacare, and the Court’s decision to strike it down will inevitably bring into question one of its most popular parts – coverage of pre-existing conditions. However, there are alternative ways to maintain that coverage, including ideas that were rejected in favor of the mandate. The fact is, there’s enough the public likes about Obamacare that if the Court strikes down the individual mandate, it won’t be the end. It will just be the end of the first round.
