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Robert Reich
NationofChange / Op-Ed
Published: Friday 15 June 2012
“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.”

A Back Door to the Public Option

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Any day now the Supreme Court will issue its opinion on the constitutionality of the Accountable Care Act, which even the White House now calls Obamacare.

Most high-court observers think it will strike down the individual mandate in the Act that requires almost everyone to buy health insurance, as violating the Commerce Clause of the Constitution — but will leave the rest of the new healthcare law 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.

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. 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.”

So in striking down the least popular part of Obamacare - the individual mandate - the Court will inevitably bring into question one of its most popular parts - coverage of pre-existing conditions. And in so doing, open alternative ways to maintain that coverage - including ideas, like the public option, 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 that won’t be the end. It will just be the end of the first round.

This article was originally posted on Robert Reich's blog.



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ABOUT Robert Reich

 

ROBERT B. REICH, one of the nation’s leading experts on work and the economy, is Chancellor’s Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. Time Magazine has named him one of the ten most effective cabinet secretaries of the last century. He has written thirteen books, including his latest best-seller, “Aftershock: The Next Economy and America’s Future;” “The Work of Nations,” which has been translated into 22 languages; and his newest, an e-book, “Beyond Outrage.” His syndicated columns, television appearances, and public radio commentaries reach millions of people each week. He is also a founding editor of the American Prospect magazine, and Chairman of the citizen’s group Common Cause. His widely-read blog can be found at www.robertreich.org. Robert Reich's new film, "Inequality for All" is available on DVD
and blu-ray, and on Netflix in February.

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7 comments on "A Back Door to the Public Option"

lighthouses7

June 16, 2012 9:22am

I would be very leery of a belief that the strike down of the Individual Mandate and the subsequent passage of a Single Payer plan passed at the behest of the HC Industry could be viewed as a progressive coup. We must not lose sight of the forest for the trees. Look at how big Pharma managed the passage of Medicare Part D

Riconui

June 15, 2012 11:32pm

When we accept health care as a right, as it should be, we will recognize that it cannot be regarded as another commodity like a can of beans. The claim can be made that a market model works really good for some things like saddling us with toxic hair dyes and providing corn sugar infused foods that are turning us into a nation of fat asses, but health care simply isn't one of those things. The purpose of a corporation is to make money for it's investors. There is simply no profit in people who are indigent AND sick. Tch, tch!

mlane78212

June 15, 2012 9:59pm

I live in France with SOCIALIZED medicine. Yes, folks, SOCIALIZED. Oooh, scary!! It is fantastic. I can pick any doctors I want, I don't have to wait months for an appointment, all doctor visits are 28 euros for me (free for the French) and the average prescription runs 3 euros. Yes, France is running out of money, but they know it and are working on ways to keep their social programs. Taxes are used mostly for the benefits of the French people. Novel idea. Instead of pounding money down the military rathole and letting agribusiness, the oil industry, and the pharmaceutical industry run things, the people actually benefit from leaders who care about them. Obama does care but he has a hard time showing it because the majority of the congress don't give a rat's ass about anything but their own (asses). Okay...so don't make people buy insurance. Don't ask everyone to step up to the plate for the common good. Then at least turn the non-payers away from the emergency rooms when they come in for ME to pay for their sore throats.

Btrwy

June 15, 2012 4:34pm

The public option is inevitable. Everyone was hoodwinked and don't even know it. Watch.

overeasy

June 15, 2012 4:00pm

The biggest problem I see with this law is that the Obama administration did an absolutely horrible job of explaining it and promoting it. Stop your average Joe on the street and ask them about "Obamacare" and I'll guarantee you that you'll get a glassy-eyed stare. Obama got it passed and then, essentially, turned his back on it -- even as he knew it was going to be a contentious issue and one that could sidetrack his governance and his future prospects. Worse yet, but doing so little to support the law, he almost begged for it to be rescinded -- leaving all of us in worse shape than we were before.

As to the concept of "pre-existing conditions?" This is such a conceptually bankrupt phrase that is boggles the mind. We ALL have pre-existing conditions of one sort or another. Even a seemingly healthy 25 year old has underlying genetics which may cause he or she to become ill sometime.

I am sick of the assault on health care, but, to repeat, Obama and his did precious little to make the law popular. Shame on them.

PHILLIP V BITTLE SR

June 15, 2012 6:34pm

"... stop your average Joe on the street and ask them about _________________ (fill in the blank) and I'll guarantee you that you'll get a glassy-eyed stare ... "

smags72

June 15, 2012 3:00pm

"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."

Are we talking about the same Congress here?? They don't give a hoot about what the public wants, DREAM ON if you think that's going to happen!