The health-care stool

Obamacare can’t work without the individual mandate

As Evan Tuchinsky reports in this issue (see Healthlines, page 12), next week the U.S. Supreme Court will take up the constitutionality of the Obama administration’s monumental health-care-reform effort, the Patient Protection and Affordable Care Act, aka Obamacare. It could be the most significant ruling of Chief Justice John Roberts’ tenure.

The focus will be on the act’s so-called individual mandate, which requires people to purchase health insurance. As Massachusetts’ experience with Romneycare has shown, the act’s success will depend on that mandate.

That’s because it’s based on a three-legged stool: Insurance companies are required to cover anyone who applies, including the sick; everyone is required to have insurance, including the young and healthy; and subsidies are provided for those who can’t afford their policies.

Currently, less than 5 percent of Massachusetts residents are uninsured—the lowest rate in the country.

Altogether, more than 50 million Americans lack health insurance, which means they are just a serious illness or a car accident away from financial catastrophe. They are also more likely to put off getting treatment and to use the emergency room as a last resort.

In February, the Centers for Disease Control and Prevention reported that 20 percent of U.S. families are having trouble paying their medical bills, with half of them unable to pay anything. Most don’t qualify for Medicaid but are too poor to afford insurance.

For millions of Americans, Obamacare offers the last, best hope for health-care security. If the court pulls one of the legs out from under the stool, Chief Justice Roberts’ legacy will be tarnished forever.