A federal judge in Texas recently struck down Obamacare as unconstitutional. He’s entirely correct.
With Republicans eliminating the individual mandate, what remains of Obamacare cannot stand on its own. It’s like a bar stool with only two legs.
The Patient Protection and Affordable Care Act (aka Obamacare) made patients less safe (by restricting choice of doctor/treatment) and healthcare more expensive. But the problem it was originally intended to address was very real. Millions of Americans were going without insurance, getting sick, clogging up emergency rooms and running up debts they’d never be able to pay back.
So in 2009, Obama and congressional Democrats decided to completely redesign US healthcare in a bid to prevent sick people from ending up without insurance. The backroom deals they struck with insurers and lobbyists were murky to say the least. Ultimately, the Democrats hatched a half-baked compromise to keep everyone happy: All people would be forced to buy insurance, but insurers would also have to sell to everyone, even the very sick, for the same price.
It was certainly unconstitutional, but it made some sense— it was intended as a one-off “deal with the devil” in which everyone would get insured, and from then on keep their insurance.
From the get-go, things went wrong. Congress could not force people by law to buy insurance, so instead they levied a tax penalty. The tax was based on income, so the young, low-income people who had previously neglected insurance still didn’t buy it. But the old and sick, whose heavy costs were supposed to be offset by the young, did buy in now that they could, driving prices up.
In 2017, the Republican tax plan eliminated the individual mandate penalty entirely. Under the system we have today, anyone can wait till they get sick, then (provided they can hold out until the next open enrollment period) go and buy insurance for the same price as anyone else.
This is obviously a broken, unsustainable model. You can’t buy car insurance after an accident. You can’t buy life insurance after someone dies.
The insurance business depends on people paying forward and in return to eliminating their risk of catastrophic payments. Instead, some can now eliminate any risk of having to pay an extra dime for healthcare, even if they make irresponsible choices. The rest of us, who purchase insurance prior to illness and try to live healthily, are left footing their bill.
Like a two-legged bar stool, the rest of Obamacare simply cannot stand on its own.
For this reason, the federal judge in Texas has ruled the current version of Obamacare unconstitutional. The individual mandate, arguably unconstitutional in itself, was the linchpin of the rest of the law. Without it, we’re living in a Wild West where insurers are forced to jack prices up each year just to stay in the market.
The ruling is likely to get challenged and make its way to the Supreme Court. Till then, the whole country is, in a sense, “uninsured,” with no plan for what the future may hold.
Adam Barsouk is a medical student, cancer researcher and science and health policy writer. Follow him on Facebook and Twitter.
