The Individual Mandate: Patient Protection and Affordable Care Act

The Individual Mandate Element of the Patient Protection and Affordable Care Act First Name and Last Name Class Date Introduction The nature of public policy is that it is informed by evidence obtained through the collaboration of various stakeholders with interest in meeting the public’s changing needs. Public policy, therefore, aims at achieving certain current and future goals. Such was the case with the Patient Protection and Affordable Care Act (PPACA) and in specific, the individual mandate element, which has been controversial since the PPACA was signed into law. To better understand the individual mandate and its surrounding controversy, it is important first to understand the goal of the PPACA. PPACA was formulated as part of the health care system reform in the United States (U.S.) by President Obama with the aim of (i) improving access to health care, (ii) protecting patients, and (iii) lowering the cost while improving the quality of health care. The element of the individual mandate was part of the strategy put in place to meet these goals, especially the one for patient protection. It refers to the requirement by law for citizens to have insurance coverage, failure to which results in a penalty. However, this element has raised many controversies and was recently repealed by President Trump’s government. This paper aims at understanding the worldview bases for and against the individual mandate element, the conflicting roles, and limits of the government, and the consequences of the mandate and its annulation.[M. BIBLIOGRAPHY \l 1033 Fitzgerald, T. Bias, and T. Gurley-Calvez. "The Affordable Care Act and Consumer Well-Being: Known and Unknowns." Journal of Consumer Affairs 51, no. 1 (2015): 1-27.] [Fitzgerald, Bias, and Gurley-Calvez, “The Affordable Care Act,” 4.] Worldview Bases for the Individual Mandate The individual mandate has evoked many emotions among different stakeholders within the U.S. health care system since its inception. The decision to make individual mandate a provision for the PPACA was largely informed by the successful implementation of such a clause in the Massachusetts health care reform. This provision in Massachusetts proved helpful in decreasing the number of uninsured individuals and given that the goal of PPACA was to increase access to health care, this provision seemed practical. When the number of individuals with health coverage increases, the cost of care in the health care system is likely to reduce because there will be less unpaid medical bills that are transferred to the rest of the citizens, a high number of uninsured individuals only imply that there will be more uncompensated care because while access is not universal, getting sick is universal. This worldview has policy implications in public health because it is in line with the need to reduce the overall burden of health care cost.[BIBLIOGRAPHY \l 1033 Molly Frean, Jonathan Gruber, and Benjamin Sommers. "Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act." Journal of Health Economics 53 (2017): 72-86.] [Frean, et al., “Premium Subsidies,” 74.] [Frean, et al., “Premium Subsidies,” 74.] Further, the individual mandate reduces possible adverse selection. It is revealed that the implementation of the individual mandate consequently led to improved consumer welfare in the market. This could be attributed to the favorable risk pooling that is provided by a larger number of people with health insurance coverage. The improved welfare for consumers is also linked to a decrease in the probability of adverse selection. The goal of increasing access to all Americans was to ensure that no one was discriminated from accessing care and one way to ensure this is to eliminate adverse selection by increasing the risk pools of insured consumers. Large risk pools have also been associated with low premiums for insurance consumers. This was one of the targets of the PPACA; to reduce the costs associated with access to care by reducing the premiums. Thus, the individual mandate provides an opportunity to increase access to all while reducing the burden of cost that has been affecting the U.S. health care system for years. This is especially important given that the U.S. is the only high-income country without some form of universal coverage.[BIBLIOGRAPHY \l 1033 Martin B. Hackmann, Jonathan T. Kolstad, and Amanda E. Kowalski. "Adverse Selection and an Individual Mandate: When Theory Meets Practice." American Economic Review 105, no. 3 (2015): 1050.] [Martin, et al., “Adverse Selection,” 1053.] Worldview Bases for the Oppositions to the Individual Mandate As mentioned earlier, the individual mandate came with its share of opposition. This opposition is based on several worldviews. First, those opposing the mandate consider it unfair for forcing people to obtain health insurance and restricting their freedom. Given that the U.S. is a free and fair country, it makes sense why people would feel like their freedom is being taken from them due to government’s coercion and impositions in the health care system through tax penalties. It raises questions on how far the government should go when it comes to making decisions for its citizens. The individual mandate was formulated around the concept of sharing risks and benefits. However, the benefits are not visible to perfectly healthy individuals who feel that they do not need insurance unless they get sick.[BIBLIOGRAPHY \l 1033 Tamara Thompson. The Affordable Care Act. (Farmington Hills, MI: Greenhaven Press, 2015), 10.] [Thompson, Affordable Care Act, 10.] Second, the legality of the individual mandate provision has also been put to the test. The mandate was challenged in court after it was included as a provision of the PPACA, although it was eventually termed constitutional. The opposition, in this case, is based on the view that by imposing a penalty for failure to comply with the individual mandate, the government is interfering with an existing free market economy in the health care industry. As such, this worldview is strongly based on the need for a free market where the government has no control over the demand and supply of health care.[Thompson, Affordable Care Act, 10.] The idea that an individual mandate is a form of socialized health care system has also formed the basis of opposition to the provision. The U.S. does not have a universal health care system, and the concept of socialized care is foreign, hence the opposition. This raises policy implications because it is evident that the pursuit of universal health care in the U.S. will require a change in the mindset of the public and policymakers. The U.S. is firmly engrained in a culture of individuality, hence the strong opposition on the individual mandate provision of the PPACA.[Thompson, Affordable Care Act, 10.] Conflicting Views to the Role and Limits of Government concerning the Individual Mandate Since the individual mandate imposes a tax penalty on individuals who fail to obtain health insurance, the government’s role is very evident. It lies in the formulation of the clause and its implementation as a law. The federal government and the IRS in particular, play a role in enforcing the mandate. According to Dalen, approximately 40% of Americans believe that the government has a major role in ensuring that everyone has access to insurance coverage and universal care. The remaining 60% have little faith in the government and do not, therefore, believe that ensuring universal access to health care should be the responsibility of the government. Some individuals think that the government should take charge of eliminating any barriers that would hinder risk pooling from ensuring that affordable premiums are available to all. However, others believe in a free market where the demand, supply, and cost of health care should be between the providers and the consumers. This raises conflict on what role the government should play and more importantly, on whether the government should be involved at all. The concept of a...