It's not the mandate that's the fatal flaw in the Affordable Care Act

As you’re no doubt aware, the Supreme Court spent the last week debating the legality of the Patient Protection and Affordable Care Act (ACA) — specifically, the individual mandate, which requires everyone of legal age to buy health insurance (though subsidized to some extent for those who can’t afford it) or be penalized. The mandate’s purpose is to broaden the risk pool and remunerate the health-insurance companies (whether they really need is another matter) for new costs generated by one of the ACA’s chief selling points: that pre-existing conditions won’t disqualify Americans from health-care coverage.

Coverage for pre-existing conditions would be cause for celebration were it part of a bill that actually did provide affordable care for all. You may be one of those lucky few whose employer pays the bulk of your premium, but that’s increasingly rare for the middle-class. Currently, for most of us, if your employer is providing you with healthcare insurance, you’re likely paying around $850 a month (pre-tax), and at least a couple hundred more if you’re self-insured. In our household that’s known as Second Rent.

In fact, the ACA is intended to “moderate premium hikes.” Never mind the future cost of premiums: many of us can scarcely pay our premiums today. How, one wonders, can the ACA be considered major legislation when it fails to deal with the central issue (deductibles and medical care that insurers won’t cover aside for the moment) — the cost of healthcare insurance this very minute.

On March 29 CNN Money reported:

… health care costs are continuing to eat away at consumers’ budgets. The cost to cover the typical family of four under an employer plan is expected to top $20,000 on health care this year, up more than 7% from last year, according to early projections by independent actuarial and health care consulting firm Milliman Inc. In 2002, the cost was just $9,235, the firm said.

In fact …

… even if the Affordable Care Act goes through, it will do little to lessen the financial burden for those who are already insured, Mayne said. “It will take other changes to really bend the cost curve and make substantial changes in health care costs,” she said.

Even though rejecting the individual mandate effectively amounts to “live free and die,” Americans don’t like to think they’re being coerced. Between that and the failure to address the cost of premiums, middle-class Americans wonder about the ACA: “Huh? What’s in it for me?”

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