A broad coalition of health advocacy groups like the American Association of People with Disabilities, the National Breast Cancer Coalition, the Ovarian Cancer National Alliance and United Cerebral Palsy have all filed an amicus brief in support of the government’s motion to dismiss Virginia’s lawsuit challenging the constitutionality of the individual health insurance mandate. [Read it HERE]
The main contention here is that without an individual requirement, individuals will join health care plans only when they become sick and the government will lose all its ability to require that insurers provide coverage without regard to pre-existing conditions. Consequently, many of the individuals with chronic conditions won’t be able to find affordable coverage or afford the available coverage.
The brief goes through the extensive history of states trying to exclude pre-existing condition exclusions without also instituting a minimum benefit requirement and chronicles some of the real world implications of eliminating the mandate:
- KENTUCKY: “The departure of nearly all insurers from Kentucky’s individual market is probably the most widely known aspect of its reforms…Kentucky’s reforms were eventually repealed in 1998.”
- MAINE: “A 2001 report found that 13 of 18 major carriers ceased issuing new policies to individuals during the eight years since the provision bceame law,” in 1993….”Many insurance providers doubled their premiums in just three years or less, and all but one of the state’s HMOs experienced ‘at least one rate increase of 25% or more in 1998 or 1999.”
- NEW HAMPSHIRE: “New Hampshire was nearly left with no carriers in the market when Blue Cross Blue Shield of New Hampshire announced it was withdrawing from the individual market.”
- NEW JERSEY: “After New Jersey’s preexisting conditions provision took effect in 1993, the state’s individula insurance market became plagued by skyrocketing premiums. Between 1996 and 2001, the cost of the most generous individula insurance plans rose by more than 350 percent.”
- NEW YORK: “New York enacted preexisting condition provisions for the individual market in 1993. Consequently, the portion of non-elderly New Yorkers without insurance worsened from 16.5 percent in 1992 to 20 percent in 1997.”
- VERMONT: “Saw substantial increases in premiums after its similar insurance reform measures took effect in 1993.”
- WASHINGTON: “Within just a few years, non-managed care options disappeared entirely from the individual market…the ‘trend since 1994 has been toward higher deductible and /or more managed products as insurers have progressively closed lower deductible, less tightly managed products.”
The legal conclusion is this: “Comprehensive health reform which includes a preexisting conditions provision must have an accompanying minimum coverage provision to be successful. Because a minimum coverage provision is essential to enacting the ACA’s preexisting conditions provision, it falls squarely within Congress’ authority under the Commerce and Necessary and Proper Clauses.” But I think the larger point is, as Yglesias put it, “these kind of facts are going to be hurdles to the ongoing conservative repeal campaign. Faced with a large and complicated piece of legislation, it’s easy to seize on some aspect or another as the reason to vote no. But it’s much harder to say yes to a repeal movement that would leave a hole in your state’s budget” or, I might add, when some of the nation’s most influential and trusted health groups are lobbying against it.