Tens of millions of people every year decide they can’t afford or simply won’t buy health insurance. Some are out of work or underemployed. Many are young and early in their working careers, self-employed or without access to large group plans through work.
The Obama administration wants to cover 30 million more people by providing incentives for nearly everyone to buy insurance. The Affordable Care Act expands government programs such as Medicaid, offers subsidies for lower-income people and imposes a penalty for those who don’t sign up with a private, employer-based or government plan.
Now the individual mandate to buy insurance is in the cross hairs of a challenge to the law by Florida, 25 other states and business groups before the U.S. Supreme Court. Among other objections, opponents say forcing people to purchase insurance or pay a penalty is a step too far, an unconstitutional overreach by the government.
The court’s decision, expected as a landmark ruling in June or July, could uphold the law, strike it down or perhaps kill the mandate while leaving other parts intact.
But if the law and the mandate survive, there’s still a fundamental problem with incentives, said Bruce Vogel, associate professor in the Department of Health Outcomes and Policy at the University of Florida’s College of Medicine.