A back door to the public option

Healthcare reform is popular enough to outlive the individual mandate

Topics: Healthcare Reform,

A back door to the public optionSupporters of healthcare reform rally in front of the Supreme Court. AP/Charles Dharapak
This originally appeared on Robert Reich's blog.

Any day now the Supreme Court will issue its opinion on the constitutionality of the Affordable Care Act, which even the White House now calls Obamacare.

Most high-court observers think it will strike down the individual mandate in the Act that requires almost everyone to buy health insurance, as violating the Commerce Clause of the Constitution — but will leave the rest of the new healthcare law intact.

But the individual mandate is so essential to spreading the risk and cost of healthcare over the whole population, including younger and healthier people, that some analysts believe a Court decision that nixes the mandate will effectively spell the end of the Act anyway.

Yet it could have exactly the opposite effect. If the Court strikes down the individual mandate, health insurance company lobbyists and executives will swarm Capitol Hill seeking to have the Act amended to remove the requirement that they insure people with preexisting medical conditions.They’ll argue that without the mandate they can’t afford to cover preexisting conditions.

But the requirement to cover preexisting conditions has proven to be so popular with the public that Congress will be reluctant to scrap it.

This opens the way to a political bargain. Insurers might be let off the hook, for example, only if they support allowing every American, including those with preexisting conditions, to choose Medicare, or something very much like Medicare. In effect, what was known during the debate over the bill as the “public option.”



So in striking down the least popular part of Obamacare — the individual mandate — the Court will inevitably bring into question one of its most popular parts: coverage of preexisting conditions. And in so doing, open alternative ways to maintain that coverage, including ideas, like the public option, that were rejected in favor of the mandate.

The fact is, there’s enough the public likes about Obamacare that if the Court strikes down the individual mandate that won’t be the end. It will just be the end of the first round.

Robert Reich, one of the nation’s leading experts on work and the economy, is Chancellor’s Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. Time Magazine has named him one of the ten most effective cabinet secretaries of the last century. He has written 13 books, including his latest best-seller, “Aftershock: The Next Economy and America’s Future;” “The Work of Nations,” which has been translated into 22 languages; and his newest, an e-book, “Beyond Outrage.” His syndicated columns, television appearances, and public radio commentaries reach millions of people each week. He is also a founding editor of the American Prospect magazine, and Chairman of the citizen’s group Common Cause. His new movie "Inequality for All" is in Theaters. His widely-read blog can be found at www.robertreich.org.

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