Week of March 28, 2011
As expected, the Patient Protection and Affordable Care Act (PPACA) was the subject of cheers and jeers as the one-year anniversary of its signing was marked last week. The White House released a celebratory video to mark the occasion, but it was quickly followed by critical videos on health reform featuring Senator Mitch McConnell and House Speaker John Boehner. In Pennsylvania, the U.S. House Energy and Commerce Subcommittee on Health held a field hearing on the law’s “year of broken promises,” which prompted several pro-reform groups to hold a “counter-hearing” in the state rotunda. The punches and counter-punches could be seen from one end of the country to the other. What do most Americans think about it all? They are just as divided, according to new polls from Gallup and CNN. In fact, the split has barely changed at all in 12 months and shows no signs of changing significantly anytime soon.
In response to a request from Senator Ben Nelson (D-NE), the Government Accountability Office (GAO) last week released a report on alternative approaches to the PPACA’s individual mandate if the individual mandate is struck down by the courts. The two big takeaways from the report are: 1) The mandate is essential for the key insurance reforms (e.g. guaranteed issue) to work and 2) without the mandate the only alternative would be to put in place a combination of multiple approaches to encourage voluntary enrollment in health insurance coverage. No single approach would do as much as the mandate to pull people in. The report examined a number of possible alternative approaches, including modification of enrollment periods with late enrollment penalties, expanded employer roles in auto-enrolling employees, public education campaigns, imposing a tax to pay for uncompensated care, allowing greater variation in premium rates based on enrollee age, making the receipt of certain government services conditional on supplying proof of insurance coverage, and using insurance status as a factor in determining credit ratings, The GAO experts also emphasized that independent research is required to fully evaluate the potential effectiveness of any single approach or combination of approaches. Without a mandate, the failure to adopt some mechanism to enlarge the insurance pool would result in a $57 billion a year tax on insured Americans to cover the costs of those without insurance, according to the GAO.