Resolved: The U.S. government should not require its citizens to have health insurance.

 

Product Description: Topic analysis essays and evidence on the March 2013 Public Forum resolution. Topics covered include whether an individual mandate is Constitutional, the role of an individual mandate in controlling costs and preventing health status discrimination, concerns about excessive government power, and much more.

 

Contributors: Jessica Bailey, Mollie Cowger, Adam Torson, Nate Zerbib-Berda

 

Table of Contents:

TABLE OF CONTENTS 2

TOPIC ANALYSIS BY JESSICA BAILEY 5

TOPIC ANALYSIS BY MOLLIE COWGER 19

TOPIC ANALYSIS BY ADAM TORSON 24

TOPIC ANALYSIS BY NATE ZERBIB-BERDA 32

FRAMEWORK EVIDENCE 38

INDIVIDUAL MANDATE DEFINED 38

ACA PROVISIONS IN RELATION TO THE INDIVIDUAL MANDATE 39

AFFIRMATIVE EVIDENCE 40

CONSTITUTIONALITY 40

THE INDIVIDUAL MANDATE IS INVALID UNDER THE COMMERCE CLAUSE BECAUSE IT REGULATES ECONOMIC INACTIVITY RATHER THAN ECONOMIC ACTIVITY 40

THE POWER CLAIMED BY CONGRESS IN REGULATING ECONOMIC INACTIVITY IS OF UNPRECEDENTED SCOPE 41

CONGRESS DID NOT INTEND TO EXERCISE ITS TAXING CLAUSE POWERS IN ENACTING THE INDIVIDUAL MANDATE 42

THE PENALTY FOR FAILING TO BUY HEALTH INSURANCE DOES NOT EVEN PURPORT TO BE A TAX 43

THE INDIVIDUAL MANDATE CANNOT BE CONSTRUED AS A TAX BECAUSE IT DOES NOT RAISE REVENUE 44

CONGRESS CLEARLY ENFORCES THE INDIVIDUAL MANDATE THROUGH A PENALTY, NOT A TAX 45

FREE-RIDING 46

THE ARGUMENT THAT THE INDIVIDUAL MANDATE PREVENTS FREERIDING IS MISPLACED 46

IT DOESN’T MAKE SENSE TO CHARACTERIZE PEOPLE AS FREERIDERS WHEN THEY COULDN’T AFFORD TO BUY INSURANCE ANYWAY 47

THE INDIVIDUAL MANDATE DOES NOT SOLVE THE PROBLEM OF MIDDLE-INCOME “FREE RIDERS” 48

IF PEOPLE WHO BUY INSURANCE LATE IN LIFE HAVE HIGHER MEDICAL COSTS, THE SOLUTION IS TO PERMIT INSURANCE COMPANIES TO CHARGE HIGHER PREMIUMS FOR THOSE PEOPLE 49

HURTS SMALL BUSINESS 50

AN INDIVIDUAL MANDATE HURTS SMALL BUSINESS BY INCREASING THE COST OF HEALTH INSURANCE AND INCREASING TAXES 50

AN INDIVIDUAL MANDATE HURTS SMALL BUSINESSES BECAUSE IT ENCOURAGES FIRMS TO DROP THEIR HEALTH INSURANCE COVERAGE AND PUTS SMALL FIRMS AT A COMPETITIVE DISADVANTAGE 51

TAX REFORM AND DEREGULATION IN THE HEALTHCARE MARKET ARE A BETTER STRATEGY FOR HELPING SMALL BUSINESSES SUCCEED 52

COST SHIFTING 53

AN INDIVIDUAL MANDATE IS JUST A COST SHIFTING SCHEME HARMING THE YOUNG AND HEALTHY 53

REFRAINING FROM BUYING INSURANCE ONLY INCREASES THE COST TO OTHERS IF THE PREMIUMS ONE WOULD PAY ARE ABOVE THE ACTUARIAL VALUE OF THE POLICY 54

HEALTHCARE COST CONTROL 55

INCREASING THE POOL OF INSURED PEOPLE WILL INCREASE DEMAND FOR MEDICAL SERVICES AND THEREFORE PRESSURE PRICES TO RISE 55

THE ACA PLACES A HUGE STRAIN ON THE SOCIAL SAFETY NET 56

THE INDIVIDUAL MANDATE RELIES ON HEALTHCARE COST CONTROL, BUT THE ACA DOES NOT HAVE GUARANTEED MEASURES TO ADDRESS THIS PROBLEM 57

PROJECTED HEALTHCARE SAVINGS GENERATED BY THE INDEPENDENT PAYMENT ADVISORY BOARD ARE NOT THAT SIGNIFICANT 58

THE ACA WILL NEED SUPPLEMENTAL LEGISLATION TO CONTROL COSTS IF CONGRESS WANTS TO MAINTAIN THE INDIVIDUAL MANDATE 59

CLAIMS THAT THE ACA WILL REDUCE THE OVERALL COST OF HEALTH SPENDING TO OUR ECONOMY ARE HIGHLY DUBIOUS 60

THE ACA MAY WELL INCREASE HEALTHCARE SPENDING IN OUR ECONOMY 61

IN THE NEAR TERM, THE COSTS OF HEALTH INSURANCE TO INDIVIDUALS SEEMS TO GO UP 62

IT IS NOT CLEAR THAT THE INDIVIDUAL MANDATE IS NECESSARY TO PREVENT HEALTH INSURANCE PREMIUMS TO SPIRAL OUT OF CONTROL 63

RESEARCHERS HAVE BEEN UNABLE TO FIND PREMIUM SPIRALS IN CASES WHERE THEY WOULD BE EXPECTED 64

THE EFFECTS OF A PREMIUM SPIRAL FROM FORGOING THE INDIVIDUAL MANDATE HAS BEEN OVERSTATED 65

THE NUMBER OF EMPLOYERS WHO WOULD DROP COVERAGE WITHOUT A HEALTH INSURANCE MANDATE IS NOT AS SIGNIFICANT AS SOME HAVE PREDICTED 66

NO SOLVENCY 67

AN INDIVIDUAL MANDATE WILL FAIL TO MEET ALL OF ITS PURPORTED GOALS 67

THE ACA’S OPEN ENROLLMENT PERIOD SHOULD DISCOURAGE WORKERS FROM GOING TOO LONG WITHOUT HEALTH COVERAGE 68

REPEAL OF THE ACA LOOKS VERY UNLIKEY; OUR FOCUS SHOULD BE ON REFORMING IT 69

NEGATIVE EVIDENCE 70

HEALTHCARE SERVICES ARE ESPECIALLY SIGNIFICANT IN QUESTIONS OF DISTRIBUTIVE JUSTICE BECAUSE HEALTH AFFECTS OUR RANGE OF OPPORTUNITIES IN SOCIAL LIFE 70

CONSTITUTIONALITY 71

THE SUPREME COURT HAS RULED THAT THE COMMERCE CLAUSE AUTHORIZES REGULATION OF ANY ECONOMIC ACTIVITY THAT IN THE AGGREGATE WOULD HAVE AN AFFECT ON INTERSTATE COMMERCE 71

FEDERAL DISTRICT COURTS HAVE FOUND THAT THE HEALTHCARE MARKET IS UNIQUE BECAUSE NOBODY CAN OPERATE WHOLLY OUTSIDE OF IT 72

THE DISTINCTION BETWEEN THE REGULATION OF ECONOMIC ACTIVITY AND INACTIVITY USED BY FEDERAL DISTRICT COURTS AND THE SUPREME COURT RELIES ON OUTDATED PRECEDENT 73

THE CATEGORICAL DISTINCTIONS BETWEEN ACTIVITY AND INACTIVITY USED TO REJECT THE COMMERCE CLAUSE JUSTIFICATION FOR THE INDIVIDUAL MANDATE WERE REJECTED IN EARLIER SUPREME COURT PRECEDENTS 74

COURTS THAT HAVE REJECTED THE INDIVIDUAL MANDATE HAVE FAILED TO APPLY THE RATIONAL BASIS TEST CORRECTLY 75

COURTS THAT HAVE REJECTED THE INDIVIDUAL MANDATE HAVE FAILED TO GIVE THE APPROPRIATE DEFERENCE TO CONGRESSIONAL FINDINGS 76

COURTS THAT HAVE REJECTED THE INDIVIDUAL MANDATE HAVE USED LOCHNER-ERA ANALYSIS THAT THE COURT HAS LONG SINCE REPUDIATED 77

SLIPPERY SLOPE ARGUMENTS ABOUT THE INDIVIDUAL MANDATE ARE UNPERSUASIVE 78

THE INDIVIDUAL MANDATE IS JUSTIFIED AS AN EXERCISE OF THE NECESSARY AND PROPER CLAUSE TO EFFECTUATE CONGRESS’S COMMERCE CLAUSE AUTHORITY 79

RACIAL, ECONOMIC, AND HEALTH STATUS DISPARITIES 80

THE GOAL OF THE ACA IS TO PREVENT HEALTH STATUS DISCRIMINATION AND SUPPORT SOCIAL SOLIDARITY 80

THE INDIVIDUAL MANDATE PROTECTS THE PROVISIONS OF THE ACA WHICH EXTEND COVERAGE TO THOSE WITH PREEXISTING CONDITIONS AND SIMULTANEOUSLY NECESSITATES MEASURES TO DRAMATICALLY EXPAND HEALTH INSURANCE COVERAGE TO THE SOCIOECONOMICALLY DISADVANTAGED 81

THE COMBINED PROVISIONS OF THE ACA WILL DRAMATICALLY REDUCE THE NUMBER OF AMERICANS WITHOUT HEALTH INSURANCE 82

UNINSURANCE AND UNDERINSURANCE CORRELATE WITH POVERTY 83

YOUNG ADULTS AND HISPANIC PEOPLE ARE DISPROPORTIONATELY UNINSURED OR UNDERINSURED 84

THE ACA WILL RESULT IN A HUGE DROP IN THE NUMBER OF UNINSURED PEOPLE 85

ADVERSE SELECTION 86

PROPONENTS OF THE ACA ARGUE THAT AN INDIVIDUAL MANDATE IS NECESSARY TO STOP ADVERSE SELECTION 86

IN MASSACHUSETTS AN INDIVIDUAL MANDATE SIGNIFICANTLY REDUCED THE PROBLEM OF HEALTHY PEOPLE NOT JONIING THE INSURANCE POOL 87

BECAUSE HEALTH INSURANCE SUBSIDIES UNDER THE ACA ARE SMALLER THAN THEY ARE IN MASSACHUSETTS, THE INDIVIDUAL MANDATE IS EVEN MORE IMPORTANT FOR INDUCING HEALTHY PEOPLE TO JOIN THE INSURANCE POOL 88

A2 FREEDOM OF CHOICE 89

THE INDIVIDUAL MANDATE ALLOWS SOME FLEXIBILITY IN SELECTING HEALTH INSURANCE 89

IMPACTS OF UNINSURANCE 90

THE UNINSURED AND UNDERINSURED WERE SIGNIFICANTLY MORE LIKELY TO FORGO ESSENTIAL MEDICAL CARE 90

UNINSURANCE AND UNDERINSURANCE LEAD TO HIGH RATES OF FINANCIAL STRESS RELATED TO MEDICAL BILLS 91

THE UNDERINSURED ARE AT GREATER RISK OF FINANCIAL HARDSHIP DUE TO MEDICAL EXPENSES 92

DESPITE BEING RELATIVELY POOR, CUBANS HAVE A SIMILAR LIFE EXPECTACY TO AMERICANS 93

A VARIETY OF INDICATORS DEMONSTRATE THAT THE UNINSURED DO NOT RECEIVE NEEDED MEDICAL CARE AND HAVE MARKEDLY WORSE HEALTH OUTCOMES 94

THE UNINSURED SUFFER EMOTIONALLY AND FINANCIALLY 95

A LARGE NUMBER OF UNINSURED AMERICANS IS HARMFUL EVEN TO THOSE WHO DO HAVE INSURANCE 96

THERE ARE ENORMOUS HIDDEN COSTS TO A HIGH UNINSURANCE RATE 97

HIGH LEVELS OF UNINSURED CITIZENS ARE VERY COSTLY TO COMMUNITIES 98

WIDESPREAD UNINSURANCE CREATES ECONOMIC INEFFICIENCY 99