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Doctors Say HealthCare Mandate Essential

November 18, 2014

While state lawsuits against the Affordable Care Act (ACA) continue, physicians are presenting their side of the argument. According to an article published this week in the Journal of the American Medical Association (JAMA), the individual mandate that all must have health insurance is the only way to expand health care access and keep costs from ballooning.

The United States’ response to the plaintiff’s motion in Coons v. Geithner is due on Aug. 10, and this week’s JAMA will come out on the same day, including a commentary by Dr. Edward Miller, dean and CEO of Johns Hopkins University School of Medicine, and Dr. Scott Berkowitz, assistant professor and medical director for Accountable Care for Johns Hopkins.

“As policymakers and the judiciary consider these challenging issues, the focus should and must remain on patients,” Miller wrote. “In the end, the health of patients relies on the health of the system providing their care, so it is imperative to get it right, and the individual mandate is an important step in that direction.”

It’s been nearly a year since the Goldwater Institute filed its lawsuit against ACA on Aug. 12, 2010 (Coons v. Geithner), and the briefing schedule is set for this fall. The suit targets the mandate requiring individuals to purchase health insurance. The mandate, and therefore the entire law, was rejected in a Florida federal court.

The judge described the mandate as an unwarranted intrusion into people’s individual choices. “Or, as discussed during oral argument, Congress could require that people buy and consume broccoli at regular intervals,” Roger Vinson, judge with the United States District Court for the Northern District of Florida, wrote in his ruling.

“Not only because the required purchases will positively impact interstate commerce, but also because people who eat healthier tend to be healthier, and are thus more productive and put less of a strain on the health care system,” the judge concluded.

Vinson said the issue was not about the health care, but that the requirement was unconstitutional, after Florida’s challenge was overruled in the 11th Circuit Court of Appeals in January. A statement released by the Department of Justice said there was a “clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law, and we are confident that we will ultimately prevail on appeal.”

Acts like the Social Security Act and Minimum Wage Act were challenged in lower courts and ultimately integrated into the legal system.

Miller’s and Berkowitz’s view is that the individual mandate will eliminate “free riding,” in which patients choose not to buy health insurance but still obtain health services, at everyone else’s expense. Making sure everyone is insured would stabilize insurance premiums, according to the doctors.

“Health care costs are reaching crisis levels and inadequate health insurance is a significant contributor,” Miller wrote. “According to the federal Department of Health and Human Services, in 2008 alone, an estimated $73 billion in uncompensated health care was provided in the United States, resulting in as much as a $1,000 increase in annual family health insurance premiums.”

The individual mandate should greatly reduce the level of uncompensated care and the resulting need to pass these costs on to those with insurance,” Miller stated.

Berkowitz added that for individuals who cannot afford health insurance, it’s a “societal obligation” to remedy that and find a way to provide those individuals with health care, but “‘free riding’ cannot be sanctioned.’”

Miller wrote that it should be clear to observers that the nation’s health insurance system has historically been dealt with in an “unfair, inequitable, and unsustainable” way.

“Ensuring that the maximum number of people possible have health insurance is crucial in improving access to, and the quality of, care,” Miller added.

In addition to Coons v. Geithner, Thomas More Law Center v. Obama is challenging the ACA under the Commerce Clause and arguing that the bill violates the 1st Amendment’s right to free exercise of religion as well.



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