Mary Brown, whose case against the 2010 healthcare reform law is pending before the Supreme Court, argues that the government shouldn't be able to force her to carry health insurance. Joined by three other individuals and a small-business trade association, she's asking the justices to rule that the law's insurance mandate is unconstitutional and that the rest of the act should be thrown out with it. But new revelations about her own situation make the case for the other side.
As The Times' David Savage reported, Brown and her husband have fallen on hard times since filing the lawsuit, largely because their auto repair business in Florida failed. The couple have filed for bankruptcy protection, asking a federal court to wipe out close to $60,000 in consumer debts. Significantly, their unpaid bills include $2,750 owed to a local hospital and physicians group and $1,735 to out-of-state medical specialists.
The disclosures are political gold for the Obama administration, transforming Brown from a champion of individual liberty into an exemplar of a problem the new law was designed to address. Uninsured and underinsured Americans rack up about $60 billion in medical bills every year that they cannot afford, forcing doctors and hospitals to pass those costs on to federal taxpayers and those patients who can pay their bills. It's not impinging on personal freedom to ask people to cover their own medical tabs. The mechanism Congress created to do that is the individual mandate.
The insurance mandate and premium subsidies in the healthcare law are expected to significantly reduce the amount of uncompensated care and cost shifting. The mandate also helps balance the law's insurance reforms, which bar companies from denying coverage to people with preexisting conditions and from making their policies prohibitively expensive. To prevent people from signing up for coverage when they need treatment, then dropping it when they're healthy, Congress required all adult Americans to maintain health insurance coverage or pay a tax penalty.
Brown and her allies contend that the law wouldn't work as Congress intended if the mandate were removed, so the entire act must be scrapped if the mandate is found unconstitutional. But her own complaints about the cost illustrate the flaw in that reasoning. Much of the law is aimed at slowing the growth of healthcare expenses and improving the quality of care. Those provisions are still valuable regardless of what happens to the mandate. Nor do the insurance reforms fail if the mandate is eliminated. Lawmakers would simply have to find another mechanism to discourage people who can afford insurance from gaming the system. Republicans in Congress have proposed several ways to do so, including financial penalties and waiting periods for people who seek insurance only when they need treatment.
Although Brown is wrong about the mandate, her concerns about cost are valid. In their zeal to make sure insurance policies were comprehensive, lawmakers didn't give people enough flexibility to save money by insuring themselves against only the largest risks. Nor have they done enough to rein in the escalating price of medical care. But those are reasons to keep building on the 2010 law, not to repeal it.