Syke Files - March 2013

MARCH 2013 RESOLVED: THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE VOLUME
3, ISSUE 7
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SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 1
PRO:
FRAMEWORK: DEFINITION OF REQUIRED TO HAVE INSURANCE .............................................................................................. 8 MANDATE IN OBAMACARE IS RESOLUTIONAL: ...................................................................................................... 9 ADVERSE SELECTION: ....................................................................................................................................................... 10 MANDATE IS A RESULT OF LOBBYING, GIFT TO INSURANCE COMPANIES: .............................................. 11 ALTERNATIVES: EMPLOYER MANDATE IS BAD TOO: ............................................................................................................................ 12 JUST TAX PEOPLE: ............................................................................................................................................................... 13 LET STATES FIGURE IT OUT: .......................................................................................................................................... 14 REMOVE MANDATES: ....................................................................................................................................................... 15 SUBSIDIZE: .............................................................................................................................................................................. 16 MANDATE ONLY WORKS AS A COMPLEMENT TO A COMPLETE OVERHAUL:.......................................... 17 COMPLIANCE: PEOPLE WONT COMPLY WITH ILLEGITIMATE, UNENFORCABLE LAWS: ................................................. 18 AUTO INSURANCE PROVES COMPLIANCE IS EMPIRICALLY LOW: ........................................................... 19 CONSTITUTION: ORIGINALISM DICTATES INSURANCE IS NOT COMMERCE: .......................................................................... 20 CONGRESS HAS NO COMMERCE GROUNDS ON WHICH TO TOUCH INSURANCE: ............................... 21 MANDATE IS UNCONSTITUTIONAL INDEPENDENT OF COMMERCE CLAUSE: ........................................ 22 MANDATE ISNT A TAX: .................................................................................................................................................. 23 DANGERS OF ACCEPTING MANDATE AS A TAX: ................................................................................................ 24 ONLY ACCEPTABLE MANDATES ARE THOSE NECESSARY TO THE EXISTENCE OF GOVERNMENT: ....................................................................................................................................................................................................... 25 NEITHER NECESSARY NOR PROPER, EXPLODES LIMITS ON POWERS: ................................................ 26 COSTS: MANDATE DOESNT REDUCE PREMIUMS OF THE INSURED: .......................................................................... 27 UNINSURED ARE THAT WAY DUE TO COSTS, NOT CHEATING: ...................................................................... 28 MANDATE DOES NOTHING TO MAKE CARE MORE AFFORDABLE:.......................................................... 29
SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 2 HIGH COSTS KEY TO CONTROLLING OVERSPENDING BY PATIENTS:.......................................................... 30 PATIENTS FEELING COSTS KEY TO REFORMING HEALTHCARE, MANDATE SHIELDS: ....................... 31 MANDATES INCREASE PREMIUMS: .......................................................................................................................... 32 MIDDLE-CLASS FAMILIES CANT AFFORD INSURANCE: .................................................................................... 33 UNINSURED WOULD USE AN ADDITIONAL $69 BILLION IN CARE: .............................................................. 34 ONLY 20% OF CURRENTLY UNINSURED CAN AFFORD TO BUY INSURANCE: ................................... 35 UNINSUREDS SPENDING WOULD SHIFT TO THE GOVERNMENT: ................................................................ 36 WOULD HAVE TO COVER THE COSTS OF CURRENTLY UNCOMPENSATED CARE: ................................. 37 FREE RIDERS: HAVING INSURANCE DOESNT SOLVE FREE RIDING: ...................................................................................... 38 UNINSURED PAY FOR A LOT OF THEIR CARE: ........................................................................................................ 39 FREE RIDING IS ONLY WORTH 3% OF HEALTHCARE EXPENDITURES: ...................................................... 40 INNOVATION: MANDATE SUBJECT TO INTENSE REGULATION: ................................................................................................... 41 OVERREGULATION DUE TO MANDATE CUTS OFF HEALTHCARE INNOVATION AT THE KNEES: ....................................................................................................................................................................................................... 42 OVERREGULATION INCREASES COSTS, IMPACT IS LESS ACCESS: ................................................................. 43 MANDATE A SLIPPERY SLOPE TO OVERREGULATION: ...................................................................................... 44 INSURANCE JOB LOCK STIFLES ENTREPRENEURSHIP (REQUIRING INSURANCE MAKES THIS WORSE?): .................................................................................................................................................................................. 45 MEDICARE/MEDICAID: MEDICAID CANT HANDLE THE INCREASED LOAD:......................................................................................... 46 PUBLIC INSURANCE ASSOCIATED WITH NEGATIVE HEALTH OUTCOMES: ........................................ 47 PUBLIC INSURANCE USES INEFFECTIVE MEASURES, LEADING TO BAD HEALTH OUTCOMES: ...... 48 MINIMUM BENEFITS: LOBBYING WILL EXPLODE THE MINIMUM BENEFITS, RAISING PRICES: ............................................ 49 MASSIVE INCREASE IN MANDATED BENEFITS INEVITABLE: ..................................................................... 50 STATES EMPIRICALLY PROVE THAT MANDATED BENEFITS WILL EXPLODE: ....................................... 51 MEDICAL GROUPS WILL LOBBY THE GOVT. FOR INCLUSION IN THE MANDATED PACKAGE: ......... 52 MEDICARE PROVES LOBBYING INCREASES MANDATED BENEFITS: ........................................................... 53 INCREASING MANDATED BENEFITS INCREASES PREMIUMS 20 TO 50 PERCENT: ........................ 54
SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 3 THE IMPACT TO INCREASED MINIMUM MANDATED BENEFITS IS LESS PEOPLE GET CARE: .. 55 LIVES: GAINING INSURANCE DOESNT HAVE A SIGNIFICANT EFFECT ON SAVING LIVES: ......................... 56 POLSKY STUDY ON MEDICARE TRANSLATES TO A GENERAL VIEW OF PROVIDING INSURANCE TO UNINSURED: ............................................................................................................................................................................ 57 MULTIPLE STUDIES HAVE SHOWN THAT PROVIDING INSURANCE DOESNT IMPROVE HEALTH OUTCOMES:.............................................................................................................................................................................. 58 UNINSURED ACTUALLY REPORT HIGHER HEALTH THAN THOSE COVERED BY MEDICARE OR MEDICAID, AND EQUAL HEALTH TO PRIVATELY INSURED: ....................................................................... 59 UNINSURED ARE BETTER OFF THAN MEDICARE/MEDICAID, EQUAL TO PRIVATELY INSURED, WHEN MEASURED BY CHRONIC CONDITIONS: ....................................................................................................... 60 DEFENDING ROSS STUDY, CAUSATION IS CLEAR, VARIABLES ARE CONTROLLED FOR, METHODOLOGY IS SOUND:............................................................................................................................................... 61 EVEN PRIVATE INSURANCE DOESNT IMPROVE HEALTH OUTCOMES SIGNIFICANTLY:............. 62 INSURANCE IS POSITIVELY CORRELATED TO OBESITY: ................................................................................... 63 OVERUTILIZATION: CHANGES MIGHT LEAD TO INCREASED HEALTH CARE USE AMONG ALREADY-INSURED: .............. 64 THOSE ON PUBLIC INSURANCE USE SIGNIFCANTLY MORE RESOURCES THAN UNINSURED: ......... 65 SLPPERY SLOPE: BROCCOLI ARGUMENT: ..................................................................................................................................................... 66 LEGAL SLIPPERY SLOPES EXIST, NOT A FALLACY: .......................................................................................... 67 MANDATE IS A CLEAR LOGICAL SLIPPERY SLOPE: .............................................................................................. 68 CONGRESS WILL ABUSE ITS NEW POWERS: ........................................................................................................ 69 STRIKING DOWN MANDATE DOESNT CREATE A SLIPPERY SLOPE: ........................................................... 70 ANSWERS-TO: A/T MANDATE KEY TO UNIVERSAL COVERAGE: .................................................................................................. 71 GRUBER/CBO INDICT: ....................................................................................................................................................... 72 A/T MASSACHUSSETTS AS AN EXAMPLE: ................................................................................................................ 73 A/T FREE RIDERS JACK UP EVERYONE ELSES PREMIUMS: ............................................................................. 74 A/T NEED MANDATE TO SOLVE DISCRIM/ADVERSE SELECTION: ............................................................... 75 A/T STATES WITH COMMUNITY RATING HAVE HIGH PREMIUMS: .............................................................. 76 A/T UNINSURED BANKRUPTCIES: ............................................................................................................................... 77
SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 4 A/T HAVING INSURANCE WILL SOLVE FOR BANKRUPTCIES:.................................................................... 78 A/T MCWILLIAMS STUDY: ............................................................................................................................................... 79 A/T REDUCES RACIAL DISPARITIES: .......................................................................................................................... 80
CON:
FRAMEWORK: DEFINITION OF REQUIRED TO HAVE INSURANCE ............................................................................................ 81 MANDATE IN OBAMACARE IS RESOLUTIONAL: .................................................................................................... 82 ADVERSE SELECTION: ....................................................................................................................................................... 83 57% UNINSURED USE MEDICAL SERVICES ANNUALLY, ALMOST ALL DO WITHIN FIVE YEARS: ....................................................................................................................................................................................................... 84 NO IMPACT TO AUTONOMY, MANDATE DOES NOT REQUIRE UNDERGOING HEALTHCARE:........... 85 UNIVERSAL COVERAGE: W/O MANDATE, NUMBER UNINSURED SKYROCKETS: ...................................................................................... 86 UNIVERSAL COVERAGE IMPOSSIBLE WITHOUT MANDATE: ........................................................................... 87 CONSTITUTION: MANDATE PERFECTLY ACCEPTABLE UNDER COMMERCE CLAUSE: ........................................................... 88 COMMERCE CLAUSE APPLIES EVEN WITH INDIRECT INFLUENCE ON COMMERCE: ............................ 89 COMMERCE CLAUSE DOESNT MATTER, NECESSARY AND PROPER WORKS: ......................................... 90 JUSTICE BLACK: INSURANCE IS JUST ANOTHER BUSINESS, BURDEN IS ON PRO: .................................. 91 CONGRESS CAN REGULATE NON-COMMERCIAL ACTIVITY AND COMMERCIAL INACTIVITY:.......... 92 FRAMERS UPHELD MULTIPLE MANDATES, INCLUDING ONE TO BUY INSURANCE: ...................... 93 MANDATE OKAY UNDER TAXING POWER: .............................................................................................................. 94 MANDATE NECESSARY AND PROPER TO UPHOLDING REST OF BILL: .................................................... 95 MULTIPLE FOUNDING FATHERS PASSED A HEALTH INSURANCE MANDATE: ................................. 96 NO HISTORICAL EVIDENCE THAT FRAMERS CONSIDERED MANDATES UNCONSTITUTIONAL:..... 97 FRAMERS MANDATES WERE MORE ONEROUS THAN HEALTH INSURANCE ONE: ........................ 98 FRAMERS MANDATES PROVE MANDATES ARE PROPER: ............................................................................ 99 ADVERSE SELECTION: WITHOUT MANDATE ADVERSE SELECTION RAISES PREMIUMS: .............................................................. 100 MASSACHUSETTS PROVE MANDATE SOLVES ADVERSE SELECTION: ................................................. 101 MANDATE WILL BE EVEN MORE EFFECTIVE NATIONALLY THAN IN MASSACHUSETTS: .............. 102 ALTERNATIVES: MANDATE IS BIPARTISAN: ........................................................................................................................................... 103 MANDATE KEY FOR PRIVATE-SECTOR BASED REFORM: ............................................................................... 104
SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 6 PREFER MANDATED BENEFITS OVER UNIVERSAL CARE: ............................................................................. 105 MANDATES HAVE LESS DEADWEIGHT LOSS THAN UNIVERSAL CARE PAID BY TAXES: ................. 106 COSTS: UNINSURED PASS THEIR COSTS ON:........................................................................................................................ 107 UNINSURED USE EMERGENCY ROOM AS SOURCE OF CARE: ........................................................................ 108 INDIVIDUALS UNDERESTIMATE ECONOMIC VALUE OF INSURANCE: ...................................................... 109 POSITIVE EXTERNALITIES DEMAND MANDATED INSURANCE: ............................................................ 110 UNINSURED USE OF E.R. COSTS BILLIONS ANNUALLY: .................................................................................. 111 UNINSURANCE = LONG-TERM DEVELOPMENTAL LOSSES FOR CHILDREN: ......................................... 112 UNINSURED LACK OF PARTICIPATION IN WORKFORCE COSTS 130 BIL ANNUALLY: ............... 113 UNINSURED DRAIN 60% OF EMPLOYER-PROVIDED HEALTH INSURANCE: ................................... 114 NO EVIDENCE IN MASSACHUSETTS THAT MANDATE INCREASED COST OF HOSPITAL CARE: .... 115 MASSACHUSETTS SHOWS MANDATE LOWERS COSTS FOR EVERYONE: ................................................ 116 EMPLOYERS CANT COVER EMPLOYEES ANYMORE: ........................................................................................ 117 ACCESS: INSURANCE INCREASES ACCESS AND REDUCES COSTS: ................................................................................ 118 MANDATE DECREASES UNINSURANCE: ................................................................................................................. 119 INCREASED INSURANCE = INCREASED MEDICAL CARE: ............................................................................ 120 MORALITY: MANDATE KEY TO STOPPING DISCRIMINATION: .............................................................................................. 121 MANDATE KEY TO PERSONAL RESPONSIBILITY: .............................................................................................. 122 ACCESS TO HEALTHCARE KEY TO OPPORTUNITY AND THEREFORE JUSTICE: ............................ 123 UNIVERSAL ACCESS TO INSURANCE KEY TO JUSTICE: .................................................................................... 124 INCREASING INSURANCE DECREASES HEALTH DISPARITIES: .................................................................... 125 MANDATE REDUCES RACIAL DISPARITIES IN ACCESS TO HEALTH CARE: ...................................... 126 LIVES: UNINSURED LESS LIKELY TO BE ABLE TO FULFILL PRESCRIPTIONS: ..................................................... 127 UNINSURED POSTPONE OR DONT GET CARE:.................................................................................................... 128 UNINSURED MORE LIKELY TO GET LATE DIAGNOSES FOR CANCER: ...................................................... 129 UNINSURED ARE 50% LESS LIKELY TO GET PREVENTATIVE CARE: ........................................................ 130
SYKE FILES MARCH 2013 THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE 7 UNINSURED LESS LIKELY TO GET GOOD CARE FOR CHRONIC DISEASES LIKE LIVER DISEASE OR DIABETES: ............................................................................................................................................................................. 131 BEING UNINSURED IS AS DEADLY AS DIABETES, STROKES, HIV, AND HOMICIDES: .................. 132 275,000 LIVES LOST IN THE NEXT DECADE DUE TO NO INSURANCE: ..................................................... 133 UNINSURED INCREASE DISEASE BURDEN AMONG COMMUNITIES: ......................................................... 134 68 TO 84 DEATHS DAILY DUE TO UNINSURANCE: ........................................................................................ 135 WARRANT LEADING FROM UNINSURNACE TO DEATH: ................................................................................. 136 CHILDREN WITHOUT INSURANCE 60% MORE LIKELY TO DIE: .................................................................. 137 300,000 HAVE DIED DUE TO NO INSURANCE SINCE 1995: ...................................................................... 138 STUDY SAYING 68 DEATHS DAILY IS LIKELY CONSERVATIVE: ................................................................... 139 GETTING INSURANCE = HEALTH GAINS: ............................................................................................................... 140 STUDIES THAT ARE DESIGNED WELL SHOW BENEFITS OF INSURANCE: .............................................. 141 MCWILLIAMS LITERATURE REVIEW IS OF 42 STUDIES: ................................................................................ 142 REVIEW OF 42 STUDIES FINDS CONSISTENT POSITIVE EFFECTS OF INSURANCE ON HEALTH: .................................................................................................................................................................................................... 143 HEALTH INSURANCE SHOWN TO BE GOOD FOR A RANGE OF DISEASES: .............................................. 144 HEALTH INSURANCE POSITIVELY CORRELLATED WITH PREVENTATIVE CARE: .............................. 145 ANSWERS-TO: A/T OVERUTILIZATION: ................................................................................................................................................ 146 A/T OVERUTILIZATION/MORAL HAZARD: ........................................................................................................... 147 A/T EVERYONE WILL GO ONTO PUBLIC INSURANCE: ..................................................................................... 148 A/T MANDATE INCREASES HEALTH CARE OVERUTILIZATION: ................................................................. 149 A/T SLIPPERY SLOPE: ..................................................................................................................................................... 150 A/T LEGAL SLIPPERY SLOPE IS DANGEROUS: ..................................................................................................... 151 A/T GUN MANDATE WAS UNDER MILITIA POWER: ......................................................................................... 152 A/T UNCONSTITUTIONAL BECAUSE ITS A PRIVATE PURCHASE:.............................................................. 153 A/T INSURERS LOBBYING PUT THE MANDATE INTO THE LAW:................................................................ 154 A/T INACTIVITY CANT BE REGULATED: ............................................................................................................... 155 A/T VERY SMALL HEALTH INSURANCE ACTIVITY: ........................................................................................... 156
PRO
FRAMEWORK
DEFINITION OF REQUIRED TO HAVE INSURANCE

The recent Massachusetts health insurance legislation, known as Chapter 58, included several features, the most salient of which was a mandate for individuals to obtain health insurance coverage or pay a tax penalty. All individuals were required to obtain coverage, with the exception of individuals with religious objections and individuals whose incomes were too high to qualify for state health insurance subsidies but too low for health insurance to be aordable as determined by the Massachusetts Health Insurance Connector Authority. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
MANDATE IN OBAMACARE IS RESOLUTIONAL:

The national health reform legislation passed in March 2010 shares many features of the Massachusetts reform, including an individual mandate to obtain health insurance coverage, new requirements for employers, expansions in subsidized care, state-level health insurance marketplaces modeled on the Massachusetts Connector, and new requirements for insurers to cover dependents to age 26, to name a few. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
ADVERSE SELECTION:
Adverse selection occurs when a larger fraction of relatively unhealthy people than healthy people purchase health insurance. It is analogous to the purchase of car insurance only by high-risk drivers (or worse, only by drivers who have just had an accident). CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
MANDATE IS A RESULT OF LOBBYING, GIFT TO INSURANCE COMPANIES:

The debates with Clinton during the primaries forced Obama to become better versed in health policy, and they may have even had some influence on his thinking about the mandate. The position of the insurance industry may also have encouraged Obama to change his position. Not long after Obama locked up the nomination, Karen Ignagni, president of Americas Health Insurance Plans the main lobbyist for the insurance companiesflew to Obamas campaign headquarters in Chicago to say that the industry would accept a reform plan that included the guaranteed issue of policies with no preexisting-condition exclusions if the legislation also included a mandate that everyone be covered. In other words, the mandate was the price for the industrys cooperation. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
ALTERNATIVES
EMPLOYER MANDATE IS BAD TOO:

Governor Schwarzenegger's proposal, meanwhile, couples an individual mandate with an employer mandate: any employer with 10 or more employees would have to provide health coverage or pay an additional payroll tax. This regulation would constitute a direct tax on employment, as businesses will find it in their interest to hire fewer employees (possibly compensating with more hours per worker) to minimize health insurance costs. Meanwhile, businesses with fewer than 10 employees will have a strong incentive not to expand, as doing so could expose them to the mandate. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
JUST TAX PEOPLE:

In one alternative, for example, the law could have imposed a tax to pay for health care, while providing an offsetting credit to those with insurance. The effect would have been identical to the mandate. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
LET STATES FIGURE IT OUT:

Or the Affordable Care Act could have delegated the responsibility of curbing free riding to the statesgiving them an open-ended menu of policies to choose from, which might have included the mandate as well as these other options. A state that followed the example of Massachusetts and enacted a mandate would then do so under state law, eliminating any constitutional challenge that could be brought in federal court. The other advantage of this approach is that the states could experiment with different policies, and the nation could learn from their results. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
REMOVE MANDATES:
A better approach to health reform would focus on removing, or mitigating the effect of, existing mandates that drive up insurance premiums. States that genuinely want to help the uninsured ought to repeal some or all of their mandated benefit laws, allowing firms to offer low-priced catastrophic care policies to their customers. If special-interest pressures hamper this solution, the federal government could assist by using its power under the Constitution's interstate commerce clause to guarantee customers the right to buy insurance policies offered in any state, not just their own. That would enable patients to patronize firms in states with fewer costly mandates. As an added bonus, state legislatures might feel pressure to ease regulations to attract more insurance business from out-of-state customers. Removing mandates would do far more to expand health care coverage than adding new mandates ever could. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
SUBSIDIZE:
Some critics simply complain that the mandate is bad policy. I have to agree; indeed, like presidential candidate Barack Obama, I opposed the mandate. There are two ways to keep healthy people in the insurance pool: mandates and subsidies. Subsidies would have been not only more politically palatable, but also less regressive because they would rely on our normal tax system. Moreover, our current health care system is so inefficient that I would not have mandated the purchase of insurance without stronger reforms to increase its efficiency. I also hate broccoli. But there is a difference between the policies one disfavors and what the Constitution prohibits. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
MANDATE ONLY WORKS AS A COMPLEMENT TO A COMPLETE OVERHAUL:

In the absence of an expansion in public coverage, health insurance market reforms, purchasing pools, or high-risk pools, or some combination, might be needed to bring the cost of coverage available to this group into the affordable range. Such reforms could also reduce the income-related subsidies that would be required to make coverage affordable. It might also be necessary to mandate that people obtain coverage once income-related financial support is available, as has been recently enacted in Massachusetts. DUBAY ET AL IN 2006 LISA DUBAY, JOHN HOLAHAN AND ALLISON COOK. MARKETWATCH, THE PEOPLE TO PEOPLE HEALTH FOUNDATION. NOVEMBER 30, 2006. THE UNINSURED AND THE AFFORDABILITY OF HEALTH INSURANCE COVERAGE. http://www.dev.mdvinteractive.com/ccf/wp-content/uploads/2012/03/The-uninsured-and-theaffordability-of-health-care.pdf ACCESSED: MARCH 1, 2013
COMPLIANCE
PEOPLE WONT COMPLY WITH ILLEGITIMATE, UNENFORCABLE LAWS:

Even though Senate Democrats chickened out from framing the penalty as a tax, the CBO decided nonetheless that people would respond to it as a tax and that, even without any major sanctions, the law would establish a new social norm leading millions of mostly low-income people to pay for health insurance. The mandate ultimately rests on little more than a hope that individuals will comply with the law because law-abiding citizens generally do comply with laws and perhaps because of an illusion that failing to pay the penalties would bring the same enforcement measures as failing to pay taxes. But a mandate that is widely seen as illegitimate is unlikely to create the social pressures on which these estimates are counting. And it will not take long for people to discover that they can defy the mandate with impunity. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
AUTO INSURANCE PROVES COMPLIANCE IS EMPIRICALLY LOW:

Forty-seven states currently require drivers to purchase liability auto insurance. Do 100 percent of drivers in those states have insurance? No. For states with an auto insurance mandate, the median percentage of drivers who are uninsured is 12 percent. In some states, the figure is much higher. For example, in California, where auto insurance is mandatory, 25 percent of drivers are uninsured more than the percentage of Californians who lack health insurance. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
CONSTITUTION
ORIGINALISM DICTATES INSURANCE IS NOT COMMERCE:

Under the original meaning of commerce, insurance contracts did not qualify. Such contracts are mere promises to pay money upon the occurrence of specified conditions, and do not involve the conveyance of goods or other items from one state to another. And so the Supreme Court held in the 1869 case of Paul v. Virginia that issuing a policy of insurance is not a transaction of commerce. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
CONGRESS HAS NO COMMERCE GROUNDS ON WHICH TO TOUCH INSURANCE:

Thus, under the original meaning of the Commerce Clause, as affirmed by the Court, Congress lacks any power over the health insurance business. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
MANDATE IS UNCONSTITUTIONAL INDEPENDENT OF COMMERCE CLAUSE:

Existing doctrine reveals the individual mandate is unconstitutional even if we assume that Congress has the power to regulate the insurance business that the New Deal Supreme Court gave it in SouthEastern Underwriters. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
MANDATE ISNT A TAX:

Considered apart from the penalty, it is obvious that the individual insurance mandate cannot have been imposed to raise revenue and therefore be justified under the power of Congress to tax. The mandate raises no revenue for the government whatsoever. To the contrary, it commands that citizens provide revenue to private insurance companies. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
DANGERS OF ACCEPTING MANDATE AS A TAX:

But the governments tax power theory is far more radical than the Commerce and Necessary and Proper Clause theory precisely because the Supreme Court has generally deferred to any invocation of the tax power to raise revenue to spend for the general welfare. This normal deference is why the mandates defenders shifted the argument from the Commerce Clause to the tax power. Yet if its theory is accepted, Congress would be able to penalize or mandate any activity by anyone in the country, provided it limited the sanction to a fine enforced by the Internal Revenue Service. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
ONLY ACCEPTABLE MANDATES ARE THOSE NECESSARY TO THE EXISTENCE OF GOVERNMENT:

To see why, consider the duties the federal government does impose on the people: register for the draft and serve if called, sit on a jury, fill out a census form, and file a tax return. None of these duties are imposed via Congresss power to regulate economic behavior. Instead, all have traditionally been considered fundamental duties that each person owes to the government by virtue of American citizenship or residency. Each of these duties can be considered essential to the very existence of the government, not merely convenient to the regulation of commerce. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
NEITHER NECESSARY NOR PROPER, EXPLODES LIMITS ON POWERS:

Either the national government has unlimited power over the people or its powers are limited. If the latter, there must be some limit to the Necessary and Proper Clause. Courts could limit its scope by examining the substance of each law to see if it is truly necessary, but this they have declined to do. Instead, the Court has developed formal doctrines to identify when an exercise of power is incidental to the regulation of commerce, and when it is remote and unnecessary. If, however, Congress is allowed to regulate any decision that has an economic effect, or that Congress deems essential to its regulatory ambitions, then the scheme of limited and enumerated powers would be at an end. Because it is both unnecessary under existing doctrine and also improper, the individual health insurance mandate is unconstitutional. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
COSTS:
MANDATE DOESNT REDUCE PREMIUMS OF THE INSURED:

With auto insurance, at least there is a reasonable argument that a well-enforced mandate could reduce insurance premiums. When many motorists are uninsured, those who do buy insurance need, and are sometimes required, to buy coverage for damage done to their vehicles by the uninsured. So when the uninsured become insured, others' premiums could fall. But this argument simply doesn't fly in the case of health insurance, because (as already noted) uncompensated care is such a small fraction of overall health spending. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
UNINSURED ARE THAT WAY DUE TO COSTS, NOT CHEATING:

Not all free riders are trying to take advantage of their fellow citizens. For many, health insurance premiums are just too high. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MANDATE DOES NOTHING TO MAKE CARE MORE AFFORDABLE:

Yet the individual mandate does nothing to make insurance more affordable. There do exist regulatory reforms that could make it more affordable, but those reforms are desirable independent of the individual mandate. The mandate seeks to command a better outcome more insured people while doing nothing to make it happen. You can't get blood from a stone. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
HIGH COSTS KEY TO CONTROLLING OVERSPENDING BY PATIENTS:

In a famous RAND study, patients with firstdollar insurance coverage consumed 43 percent more health care than patients who had to pay a large deductible, and yet the two groups experienced indistinguishable health outcomes. The obvious conclusion is that many health services have negligible benefits, but patients will get them anyway unless they face at least some portion of the costs. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
PATIENTS FEELING COSTS KEY TO REFORMING HEALTHCARE, MANDATE SHIELDS:

Effective health care reform would involve making customers more cost-conscious. The individual mandate, sadly, will tend to shield customers from costs and impede innovations that could push costs down. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MANDATES INCREASE PREMIUMS:

Using a fixed effects model, I find that the average mandate increases premiums by 0.44-1.11% annually. This implies that new mandates were responsible for 9-23% of all premium increases over the 1996-2011 period. BAILEY IN 2012 JAMES BAILEY, DEPARTMENT OF ECONOMICS, TEMPLE UNIVERSITY. OCTOBER 29, 2012. THE EFFECT OF HEALTH INSURANCE BENEFIT MANDATES ON PREMIUMS. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2107945 ACCESSED: FEBRUARY 22, 2013
MIDDLE-CLASS FAMILIES CANT AFFORD INSURANCE:

Over the last few decades, the United States has witnessed skyrocketing health care costs. Health insurance premiums have been rising on average by double-digit percentage points over the past five years, a rate of increase that is 2-3 times the rate of inflation.1 Because of these out-of-control health care costs, there has been a steep rise in the number of uninsured Americans. Currently, more than 45 million Americans lack any form of health insurance, and millions more are underinsured they have insurance but lack adequate financial protection from health care costs. While this problem was formerly a problem confined to low-income Americans, more and more middle-class citizens are becoming directly affected by the problem. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED WOULD USE AN ADDITIONAL $69 BILLION IN CARE:

The additional health care that would be used by the uninsured if they had insurance: The Institute of Medicine estimated that this would amount to $34-$69 billion per year, depending on whether the benefits package offered to the uninsured offered public insurance-level benefits (e.g. Medicaid or S-CHIP) or private insurance-level benefits. Note that this number assumes no structural changes in the systems of health care financing or delivery, average scope of benefits, or provider payment. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
ONLY 20% OF CURRENTLY UNINSURED CAN AFFORD TO BUY INSURANCE:

The 2005 Current Population Survey (CPS) is used to estimate what share of uninsured Americans are eligible for coverage through Medicaid or the State Childrens Health Insurance Program (SCHIP), need financial assistance to purchase health insurance, and are likely able to afford insurance. Twenty-five percent are eligible for public coverage, 56 percent need assistance, and 20 percent can afford coverage. DUBAY ET AL IN 2006 LISA DUBAY, JOHN HOLAHAN AND ALLISON COOK. MARKETWATCH, THE PEOPLE TO PEOPLE HEALTH FOUNDATION. NOVEMBER 30, 2006. THE UNINSURED AND THE AFFORDABILITY OF HEALTH INSURANCE COVERAGE. http://www.dev.mdvinteractive.com/ccf/wp-content/uploads/2012/03/The-uninsured-and-theaffordability-of-health-care.pdf ACCESSED: MARCH 1, 2013
UNINSUREDS SPENDING WOULD SHIFT TO THE GOVERNMENT:

The cost of covering the out-of-pocket costs the uninsured currently pay: The uninsured pay 35% of health care costs out-of-pocket, compared to 20% for the insured (8). It is estimated that of the $100 billion in care the uninsured use per year, 26% was paid out-of-pocket by the uninsured, or $26 billion. As Uwe Reinhardt wrote, If the purpose of public policy in this area were to protect American families from financial distress, then presumably some of this outof-pocket spending by the uninsured would be shifted from the uninsured to the governments budget.9 The cost of covering these out-of-pocket costs would depend on the generosity of the benefits offered to the uninsured. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
WOULD HAVE TO COVER THE COSTS OF CURRENTLY UNCOMPENSATED CARE:

The cost of covering uncompensated care costs provided by hospitals, physicians, and other providers to the uninsured: Currently, $34.5 billion a year is spent on uncompensated care costs, which includes free care, discounted care, and bad debt that is written off by the provider if the uninsured person cannot pay.8 A system that covered the uninsured would likely cover some or all of these uncompensated costs; the exact amount would depend on the specific solution in question. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
FREE RIDERS:
HAVING INSURANCE DOESNT SOLVE FREE RIDING:

First, we should note that not all free riders are uninsured. In fact, people with insurance consume almost a third of uncompensated care. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
UNINSURED PAY FOR A LOT OF THEIR CARE:

Second, not all care received by the uninsured is paid for by others. Analysts at the Urban Institute found that the uninsured pay more than 25 percent of their health expenditures out of pocket. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
FREE RIDING IS ONLY WORTH 3% OF HEALTHCARE EXPENDITURES:

So how much uncompensated care is received by the uninsured? The same study puts the number at about $35 billion a year in 2001, or only 2.8 percent of total health care expenditures for that year. In other words, even if the individual mandate works exactly as planned, it will affect at best a mere 3 percent of health care expenditures. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
INNOVATION:
MANDATE SUBJECT TO INTENSE REGULATION:

In addition to defining a minimum benefits package, an individual mandate must also specify other features of qualifying insurance policies such as their maximum payouts, deductibles, and copayments. The same political pressures that affect the benefits package will also affect these other characteristics. Health care providers have a strong financial incentive to assure that patients have low deductibles and copayments so that they will consume more services. In Massachusetts, no health insurance policy with a deductible greater than $2,000 for an individual or $4,000 for a family will satisfy the mandate. In addition, qualifying policies may not have any maximum annual or per-condition payout. And this is merely the regulatory starting point for a law that has not yet gone into full effect (some aspects of the plan won't kick in until 2009). We should expect further regulations to accumulate with the passage of time. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
OVERREGULATION DUE TO MANDATE CUTS OFF HEALTHCARE INNOVATION AT THE KNEES:

Consequently, the individual mandate will have a deleterious impact on the flexibility of health plans. Health care buyers and insurers need the opportunity to experiment with different types of coverage. Higher deductibles and copayments, for example, give patients an incentive to weigh the potential benefits of health services against their costs a key component of any effective plan to control health care costs. (Health Savings Accounts, or HSAs, could allow people to save tax-free dollars for out-of-pocket health expenses, with unused dollars rolling over to their retirement accounts.) Insurers might also want to experiment with other policies, such as plans that offer full coverage for only certain treatments for particular conditions, while requiring patients to cover the difference in price between covered treatments and more expensive ones. But the individual mandate's one-size-fitsall approach cuts off such innovation at the knees. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
OVERREGULATION INCREASES COSTS, IMPACT IS LESS ACCESS:

More important, health insurance plans with lower deductibles and copayments are more expensive. Regulations that mandate more generous plans drive up premiums, thereby pricing some people out of the market. The result is more uninsured people, more people insured only via public subsidy, or both. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MANDATE A SLIPPERY SLOPE TO OVERREGULATION:

Rising insurance premiums, as a result of a growing mandated benefits package, will fuel greater public dissatisfaction with the health care system. Further regulations that hitchhike on the individual mandate will only make matters worse. Ironically, free markets rather than government will likely catch the blame, thus fueling demand for more intrusive interventions into the health care market. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
INSURANCE JOB LOCK STIFLES ENTREPRENEURSHIP (REQUIRING INSURANCE MAKES THIS WORSE?):
Job lock refers to the idea that people stay with their jobs when they would rather work elsewhere because their current job offers health insurance. For example, many individuals opt to stay with their job instead of starting their own business because they are unsure of whether they can get health insurance on the individual market, which has higher premiums and often denies people with pre-existing conditions. Although the number of people who would be self-employed if there were universal health care is controversial, one study from 2001 put the number at 3.8 million Americans.14 This loss of entrepreneurship is a real economic cost in a society that is relying on start-ups to offset the loss of jobs that are moving offshore. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
MEDICARE/MEDICAID
MEDICAID CANT HANDLE THE INCREASED LOAD:

The erosion of employer-based coverage has been partially offset by increased enrollment in Medicaid, which is designed to provide a safety-net for the lowest income Americans. However, Medicaid has recently been the subject of relentless funding cuts by cash-strapped states and Congressional representatives who are ideologically opposed to welfare programs. As the program continues to be slashed, it is certain that Medicaid will not be able to offset the losses in employerbased insurance, resulting in more and more uninsured individuals. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
PUBLIC INSURANCE ASSOCIATED WITH NEGATIVE HEALTH OUTCOMES:

Public insurance is not associated with good health outcomes. In fact, for two out of three health measures, persons on Medicaid and Medicare alone are significantly less healthy than persons with no insurance Neither result can be attributed to initial health, age, race, gender, marital status, education, employment status, income, or economic hardship, or to sample selection. Thus, the health commodity hypothesis that medical insurance is associated with good health outcomes is not supported, but the reasons for the association between public insurance and worse health nevertheless remain unclear. Medicare and Medicaid were enacted on the premise that public insurance for the elderly and poor would help protect the health of vulnerable groups, not make it worse. It seems unlikely that public insurance could worsen health, yet comprehensive adjustments for initial health and socioeconomic and demographic characteristics raise the question of why having public insurance is associated with worse health, not better, than being uninsured. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
PUBLIC INSURANCE USES INEFFECTIVE MEASURES, LEADING TO BAD HEALTH OUTCOMES:

Given our results that Medicaid patients visit the doctor more and receive more drugs than the uninsured, but that their overall health worsens over time rather than improving, it seems possible that treating poor, publicly uninsured patients with drugs is a less effective way of producing health than alternatives that address root causes. Prescription drugs are expensive, and their use is a way for the medical profession to keep control over poor peoples health. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
MINIMUM BENEFITS
LOBBYING WILL EXPLODE THE MINIMUM BENEFITS, RAISING PRICES:

If you're going to mandate something, you have to define it. Under an individual mandate, legislators and bureaucrats will need to specify a minimum benefits package that a policy must cover in order to qualify. It's not plausible to believe this package can be defined in an apolitical way. Each medical specialty, from oncology to acupuncture, will pressure the legislature to include their services in the package. And as the benefits package grows, so will the premiums. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MASSIVE INCREASE IN MANDATED BENEFITS INEVITABLE:

The "basic" package might initially be minimal, but over time it will succumb to the same specialinterest lobbying that affects every other area of public policy. If psychotherapy is not initially included in the package, eventually it will be, once the psychotherapists' lobby has its way. And likewise for contraception, dental care, chiropractic, acupuncture, in vitro fertilization, hair transplants, ad infinitum. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
STATES EMPIRICALLY PROVE THAT MANDATED BENEFITS WILL EXPLODE:

This is not mere speculation. Even now, every state in the union has a list of mandated benefits that any health insurance policy must cover. Mandated benefits have included all of the services listed above yes, even hair transplants in some states. All states together have created nearly 1900 mandated benefits. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MEDICAL GROUPS WILL LOBBY THE GOVT. FOR INCLUSION IN THE MANDATED PACKAGE:
Given that medical interest groups have found it worth their time and money to lobby 50 state legislatures for laws affecting only voluntarily purchased insurance policies, mandatory insurance will only exacerbate the problem. If the benefits package is established at the federal level, the incentive to lobby will be that much greater. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
MEDICARE PROVES LOBBYING INCREASES MANDATED BENEFITS:

Medicare and Medicaid provide further evidence. Given the massive funds at stake in those programs, it should come as no surprise that lobbying has affected the list of covered benefits. A public outcry prevented Viagra from being covered by Medicare and Medicaid, but other drugs and services have not attracted that kind of scrutiny. In 2004, after heavy lobbying by pharmaceutical companies that make antiobesity drugs, Medicare reclassified obesity as an illness (or rather, removed language saying it was not an illness), thereby clearing the way for coverage of obesity treatments including diet pills, weight-loss programs, and bariatric surgery. Although by law Medicare can pay only for "medically necessary" services, the obesity story aptly demonstrates the subjective and ultimately political meaning of that term. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
INCREASING MANDATED BENEFITS INCREASES PREMIUMS 20 TO 50 PERCENT:

Mandated benefits drive up insurance premiums; after all, insurance companies can't make more payouts without higher revenues. Existing mandates have increased premiums by an estimated 20 to 50 percent, depending on the state. There is every reason to believe the same process will affect the minimum benefits package under an individual mandate. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
THE IMPACT TO INCREASED MINIMUM MANDATED BENEFITS IS LESS PEOPLE GET CARE:
Mandated benefits drive up insurance premiums; after all, insurance companies can't make more payouts without higher revenues. Existing mandates have increased premiums by an estimated 20 to 50 percent, depending on the state. There is every reason to believe the same process will affect the minimum benefits package under an individual mandate. As a result, even more people will find themselves unable to buy insurance and decide not to comply. Others will buy the insurance, but only by relying on public subsidies. A health policy intended to rein in free riding and cost shifting will tend to encourage more of the same. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
LIVES:
GAINING INSURANCE DOESNT HAVE A SIGNIFICANT EFFECT ON SAVING LIVES:

Study Design We use a quasi-experimental approach to compare the health effects of insurance for the nearelderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead). Results The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: 4.8, 3.3), 0.3 more in good health (95 percent CI: 3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: 7.4, 2.3), and 2.8 more dead (4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant. Conclusions Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status. POLSKY ET AL IN 2009 DANIEL POLSKY AND MANY OTHERS, HEALTH SERVICES RESEARCH VOLUME 44, NUMBER 3. PAGES 926-945. JUNE 2009. THE HEALTH EFFECTS OF MEDICARE FOR THE NEAR-ELDERLY UNINSURED. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699915/ ACCESSED: MARCH 2, 2013
POLSKY STUDY ON MEDICARE TRANSLATES TO A GENERAL VIEW OF PROVIDING INSURANCE TO UNINSURED:

By using Medicare as a quasi-experiment, we have explored whether the indirect health consequences of lacking health insurance could be arrested by providing health insurance to the uninsured. POLSKY ET AL IN 2009 DANIEL POLSKY AND MANY OTHERS, HEALTH SERVICES RESEARCH VOLUME 44, NUMBER 3. PAGES 926-945. JUNE 2009. THE HEALTH EFFECTS OF MEDICARE FOR THE NEAR-ELDERLY UNINSURED. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699915/ ACCESSED: MARCH 2, 2013
MULTIPLE STUDIES HAVE SHOWN THAT PROVIDING INSURANCE DOESNT IMPROVE HEALTH OUTCOMES:
For both subjective and objective health status measures, we did not detect a relative slowing of health decline for the previously uninsured between ages 65 and 73 when compared with the previously insured. Our evidence that Medicare does not improve the physical health status of the uninsured relative to the insured is consistent with the lack of detectible health effects from the more generous coverage groups in the RAND HIE (Manning et al. 1987). The RAND HIE, the only randomized trial to look at the question of whether generosity of benefit design in plans (with a catastrophic cap on out-ofpocket expenditures) affects health, found that while people receiving free care used more services, they did not have better health outcomes among a broad array of health measures than those with less generous coverage. POLSKY ET AL IN 2009 DANIEL POLSKY AND MANY OTHERS, HEALTH SERVICES RESEARCH VOLUME 44, NUMBER 3. PAGES 926-945. JUNE 2009. THE HEALTH EFFECTS OF MEDICARE FOR THE NEAR-ELDERLY UNINSURED. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699915/ ACCESSED: MARCH 2, 2013
UNINSURED ACTUALLY REPORT HIGHER HEALTH THAN THOSE COVERED BY MEDICARE OR MEDICAID, AND EQUAL HEALTH TO PRIVATELY INSURED:
Table 1 shows the effect of insurance on health outcomes, with adjustment for initial health, socioeconomic and demographic characteristics, and the hazard of attrition (see the first column for each health outcome). Compared with the uninsured, persons covered by Medicaid and Medicare report worse health, whereas the privately insured are not significantly different from the uninsured in their reports of health. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
UNINSURED ARE BETTER OFF THAN MEDICARE/MEDICAID, EQUAL TO PRIVATELY INSURED, WHEN MEASURED BY CHRONIC CONDITIONS:
Chronic conditions are significantly more prevalent among persons on Medicaid and Medicare than among the uninsured. The privately insured do not differ significantly from the uninsured. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
DEFENDING ROSS STUDY, CAUSATION IS CLEAR, VARIABLES ARE CONTROLLED FOR, METHODOLOGY IS SOUND:
These associations and nonassociations between medical insurance and health are not due to initial health status, socioeconomic and demographic characteristics, or sample selection. We adjust for baseline health, the hazard of attrition, gender, race, age, marital status, change in marital status over time, education, employment status, change in employment status, household income, change in household income, economic hardship, and change in economic hardship. Thus, all models include comprehensive adjustments for health and social characteristics. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
EVEN PRIVATE INSURANCE DOESNT IMPROVE HEALTH OUTCOMES SIGNIFICANTLY:

In sum, persons with private insurance do not differ significantly from the uninsured in their self-reported health, physical functioning, or number of chronic conditions, whereas persons with public insurance report worse health and more chronic conditions than the uninsured. Insurance is not associated with better health outcomes in any case. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
INSURANCE IS POSITIVELY CORRELATED TO OBESITY:

A study released last summer found that people who had health insurance were more likely to gain weight than people who lacked it. The authors, from Stanford, RAND, and University College London, found that health insurance increased body mass index by 1.3 to 2.1 points. NOAH IN 2010 TIMOTHY NOAH, STAFFER, SLATE MAGAZINE. FEBRUARY 3, 2010. HEALTH REFORM AND MORAL HAZARD. http://www.slate.com/articles/news_and_politics/prescriptions/2010/02/health_reform_and_mo ral_hazard.html ACCESSED: MARCH 2, 2013
OVERUTILIZATION:
CHANGES MIGHT LEAD TO INCREASED HEALTH CARE USE AMONG ALREADY-INSURED:

Finally, depending on the solution chosen, those who are currently privately insured may also use more health care (e.g. if health care were made available for all with no or minimal cost-sharing, there might be increased usage of health care across the board). Furthermore, there is the possibility that covering the uninsured through a public insurance program may tempt employers to drop coverage and push their employees onto the public insurance program (crowd-out); the exact magnitude of this additional cost would depend on the solution chosen. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
THOSE ON PUBLIC INSURANCE USE SIGNIFCANTLY MORE RESOURCES THAN UNINSURED:

Persons on Medicaid visit the doctor significantly more often than the uninsured. Adjustment for health in column 2 shows that this is because their baseline health is poorer Medicaid does seem to provide access to care. Persons on Medicaid also receive more medical treatment, as indicated by the number of prescription drugs they are taking Medicaid recipients take significantly more prescription drugs than others, even with adjustment for their poorer health. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
SLIPPERY SLOPE:
BROCCOLI ARGUMENT:
Opponents of the mandate argue that a decision upholding it would give Congress unlimited power to impose mandates of any kind. That includes the much-discussed broccoli purchase mandate postulated by Federal District Judge Roger Vinson, the author of one of the three district court opinions striking down the mandate. If the mandate were upheld, he explains, Congress could require that people buy and consume broccoli at regular intervals, not only because the required purchases will positively impact interstate commerce, but also because people who eat healthier tend to be healthier, and . . . put less of a strain on the health care system. Such slippery slope concerns have been prominently emphasized in three of the four federal court decisions striking down the law. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
LEGAL SLIPPERY SLOPES EXIST, NOT A FALLACY:

A legal slippery slope argument has two distinct components: logical and empirical. A logical slippery slope occurs if judges cannot coherently distinguish A from Bfor example, a health insurance purchase mandate from any other mandate that Congress might enact. It should be noted that a logical slippery slope argument need not concede that A is justifiable in and of itself and is only constitutionally suspect because it leads to B. Rather, the constitutionality of A is dependent on the quality of the reasoning justifying it. If the only available argument in its favor is defective because it inevitably also justifies something clearly unconstitutional, such as B, then A is impermissible in its own right for lack of a sound argument in its favor. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
MANDATE IS A CLEAR LOGICAL SLIPPERY SLOPE:

From the standpoint of logic, I conclude that the federal governments arguments really do lead to an unlimited congressional power to impose virtually any mandate, save a few that are precluded by the individual rights provisions of the Constitution. The same result occurs under all three of the governments major arguments for the constitutionality of the mandate: claims that the mandate is authorized by the Commerce Clause, the Tax Clause, and the Necessary and Proper Clause. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
CONGRESS WILL ABUSE ITS NEW POWERS:

The empirical aspect of the issue is more difficult to assess. It depends in part on future political dynamics that are hard to predict. Nevertheless, there is a substantial likelihood that Congress will take advantage of an unconstrained power to impose mandates for the purpose of benefiting favored interest groups. Such mandates could be made more palatable to the public by posing them as public health measures or efforts to strengthen the economy. Mandates could also be promoted by classic BaptistBootlegger coalitions, which combine public health advocates and industry interest groups. Such coalitions can effectively portray an effort to benefit an influential interest group as a measure promoting the public good. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
STRIKING DOWN MANDATE DOESNT CREATE A SLIPPERY SLOPE:

From a logical point of view, the validity of these fears depends on the reasoning adopted by the Supreme Court in a future decision striking down the mandate. In theory, the Court could do so in a decision that also overrules or severely limits important precedents. However, such logical implications do not arise from the most likely path by which the Court might strike down the mandate: holding that Congress cannot use the Commerce Clause and Necessary and Proper Clause to regulate inactivitydefined as imposing mandates merely on the basis of ones presence in the United States. Such a decision would leave intact all existing precedents and major government programs. It would not even come close to restoring Lochner, which restricted a wider range of regulatory legislation and affected state laws as well as federal ones. It is also unlikely to seriously impede future federal efforts to combat epidemics or other emergencies. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
ANSWERS-TO:
A/T MANDATE KEY TO UNIVERSAL COVERAGE:

Many liberals assume that universal health care requires an individual mandate; but there are arguably better alternatives. In fact, as the law stands, the mandate may simply not work because it lacks adequate means of enforcement. For Democrats, then, saving the Affordable Care Actlegally, politically, and practicallycould very well mean getting rid of the mandate. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
GRUBER/CBO INDICT:
But these estimates are highly speculative for one key reason: They assume substantial compliance with a mandate that has no enforcement behind it. Those who do not sign up for insurance are supposed to face a fine; but, if they dont pay it, the government cannot impose any criminal sanctions, liens on property, or levies on income. The IRS only has one clear method of collection: withholding a tax refund. As Judge Laurence Silberman of the D.C. Court of Appeals wrote in his decision upholding the mandate, [T]his provisions success depends ... on voluntary compliance. The individual mandate, in short, is a mandate only in the sense that a toy gun is a gun. There is no way to fire it, though some people will blink if it is pointed at them. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
A/T MASSACHUSSETTS AS AN EXAMPLE:

The one state with a mandate hardly offers much guidance. Massachusetts now has near-universal coverage, but, even before its recent reforms, only about 10 percent of its population was uninsured. Romneys program passed with overwhelming support from both Republicans and Democrats in the state legislature. Business, labor, and the health care industry all backed the law. And, when the mandate went into effect, the agency in charge of the program ran TV ads with stars from the Boston Red Sox saying it was time to get health insurance. In some states today, by contrast, the uninsured represent 20 percent or more of the population, and, instead of elite-led support for the health care legislation, there is elite-led opposition. Under those conditions, open defiance of the mandate will be respectable, and compliance with the mandate may be much lower than the official estimates assume. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
A/T FREE RIDERS JACK UP EVERYONE ELSES PREMIUMS:

Furthermore, more than 85 percent of uncompensated care is paid for by governments, not by private insurance. That means less than 15 percent of uncompensated care less than half a percent of all health care spending contributes to higher private insurance premiums. WHITMAN IN 2007 GLEN WHITMAN, ASSOCIATE PROFESSOR OF ECONOMICS AT CALIFORNIA STATE NORTHRIDGE. THE CATO INSTITUTE. SEPTEMBER/OCTOBER 2007. HAZARDS OF THE INDIVIDUAL HEALTH CARE MANDATE. http://www.cato.org/policy-report/septemberoctober-2007/hazards-individual-health-caremandate ACCESSED: FEBRUARY 11, 2013
A/T NEED MANDATE TO SOLVE DISCRIM/ADVERSE SELECTION:

Opponents of the mandate counter that community rating may work as long as there are large subsidies that attract healthier enrollees to the insurance pool. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
A/T STATES WITH COMMUNITY RATING HAVE HIGH PREMIUMS:

States with community rating do not generally offer such large subsidies, so we cant use their experience to predict the effects of national reform minus the mandate. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
A/T UNINSURED BANKRUPTCIES:

The most direct way in which the insured are affected by the lack of universal health care is illustrated by a 2005 study that surveyed people who filed for personal bankruptcy. In this study, 46.2% of those surveyed cited a medical cause for their bankruptcy. Of note, only 32.6% of those citing a medical cause of bankruptcy were uninsured at the time of filing, meaning that almost 7 out of 10 people in the survey were insured when they filed. In other words, high medical bills and lost income due to illness can lead to bankruptcy even for the insured CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
A/T HAVING INSURANCE WILL SOLVE FOR BANKRUPTCIES:

The problems in us health care finance are not restricted to the uninsured; our fragmented, inadequate payment system causes tremendous suffering among insured Americans as well. Research we undertook with colleagues at Harvard Law School and Ohio University found that more than half of all US bankruptcies are due, at least in part, to medical illness or medical bills (Himmelstein and Warren 2005; Himmelstein and Thorne 2009: 741746). This headline from our study was widely cited in the 20092010 health reform debate. But another of our findings received much less attentionin the overwhelming majority of medical bankruptcies, the patient had health insurance, at least when they first got sick. In our most recent data on bankruptcy filers in 2007, 78 percent of those whose illness caused a medical bankruptcy had health insurance. In some cases patients started the illness with insurance, only to lose it along with their job after they became sick. In many more cases, people had insuranceusually private health insurancewhich they held on to throughout the bankrupting illness. Yet they were bankrupted anyway by gaps in their coverage, like copayments, deductibles, and uncovered services. HIMMELSTEIN IN 2011 DAVID HIMMELSTEIN, PROFESSOR OF PUBLIC HEALTH, AND STEPHANIE WOOLHANDER, SAME, SOCIAL RESEARCH VOLUME 78 NUMBER 3. FALL 2011. HEALTHCARE REFORM 2.0. http://www.pnhp.org/sites/default/files/docs/2011/783_Woolhandler-Himmelstein_719-730.pdf ACCESSED: FEBRUARY 26, 2013
A/T MCWILLIAMS STUDY:

McWilliams et al. (2007b) used the same data and a similar strategy as this paper, but they found the acquisition of Medicare coverage to be associated with improved trends in health for the previously uninsured. These two papers ignore deaths in their analysis; they implicitly or explicitly treat subjects who died as a missing-at-random survey nonresponse. As we show in detail in our Appendix SA2, when deaths are erroneously treated as a missing-at-random survey nonresponse, the health effects for the uninsured are much greater than the insured, but when deaths are modeled as the health outcome of death, there is no significant detectable health effect for the uninsured relative to the insured. Ignoring deaths leads to a biased inference regarding the effect of Medicare on health status. POLSKY ET AL IN 2009 DANIEL POLSKY AND MANY OTHERS, HEALTH SERVICES RESEARCH VOLUME 44, NUMBER 3. PAGES 926-945. JUNE 2009. THE HEALTH EFFECTS OF MEDICARE FOR THE NEAR-ELDERLY UNINSURED. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699915/ ACCESSED: MARCH 2, 2013
A/T REDUCES RACIAL DISPARITIES:

In Table 11, we examine outcomes by race. We see more heterogeneity in the estimated changes in outcomes across the race categories than we do across other demographic categories. Although we generally see decreases in length of stay in all demographic groups, length of stay increased among Asian patients. Admissions from the emergency room also increased for Asian patients. Overall, it appears that within-race changes in outcomes are not directly related to within-race changes in insurance coverage. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
CON
FRAMEWORK
DEFINITION OF REQUIRED TO HAVE INSURANCE

The recent Massachusetts health insurance legislation, known as Chapter 58, included several features, the most salient of which was a mandate for individuals to obtain health insurance coverage or pay a tax penalty. All individuals were required to obtain coverage, with the exception of individuals with religious objections and individuals whose incomes were too high to qualify for state health insurance subsidies but too low for health insurance to be aordable as determined by the Massachusetts Health Insurance Connector Authority. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
MANDATE IN OBAMACARE IS RESOLUTIONAL:

The national health reform legislation passed in March 2010 shares many features of the Massachusetts reform, including an individual mandate to obtain health insurance coverage, new requirements for employers, expansions in subsidized care, state-level health insurance marketplaces modeled on the Massachusetts Connector, and new requirements for insurers to cover dependents to age 26, to name a few. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
ADVERSE SELECTION:
Adverse selection occurs when a larger fraction of relatively unhealthy people than healthy people purchase health insurance. It is analogous to the purchase of car insurance only by high-risk drivers (or worse, only by drivers who have just had an accident). CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
57% UNINSURED USE MEDICAL SERVICES ANNUALLY, ALMOST ALL DO WITHIN FIVE YEARS:
Thus, uninsured people generally cannot avoid being commercially active in health-care markets. They are, rather, a set of individuals who hope to be commercially inactive but predictably will actually be active. Indeed, 57 percent of the uninsured used medical services in 2007, and all but a few do so within five years. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
NO IMPACT TO AUTONOMY, MANDATE DOES NOT REQUIRE UNDERGOING HEALTHCARE:

For example, our right to liberty has been held to prevent violations of bodily integrity and would probably preclude any law requiring us to eat broccoli but such issues are not raised by the mandate, which requires paying for health insurance but does not require us to undergo health care. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
UNIVERSAL COVERAGE
W/O MANDATE, NUMBER UNINSURED SKYROCKETS:

Estimates by the influential MIT economist Jonathan Gruber and by the Congressional Budget Office (CBO) indicated that, without a mandate, the number of people remaining uninsured under the program would rise sharply. According to a 2010 CBO estimate, eliminating the mandate would raise the T:uninsured population in 2019 by 16 million; in addition, premiums paid by people who buy insurance individually would rise 15 to 20 percent because of adverse selection (that is, sicker people would be more likely to be insured). Those higher premiums would increase the cost of subsidies and reduce the popularity of the program. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
UNIVERSAL COVERAGE IMPOSSIBLE WITHOUT MANDATE:

While attacking the mandate, Obama failed to offer any policy that would accomplish the mandates purpose: preventing people from opportunistically paying for insurance only when they need it. And, without any alternative, the reforms that Obama favored, such as elimination of preexistingcondition exclusions, would drive up the price of insurance by giving people an incentive to delay purchasing coverage until they were sick. Any system that allows people to buy insurance on the way to the hospital, and then to drop it when they get back home, is bound to be very expensive. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
CONSTITUTION:
MANDATE PERFECTLY ACCEPTABLE UNDER COMMERCE CLAUSE:

During the congressional debate, legal experts consulted by Democrats all agreed there was no case against the constitutionality of a health insurance mandateand they were right that there should be no case. Opponents of the law say it is unprecedented for Congress to regulate inactivity as opposed to activity under the interstate commerce clause, but the Constitution provides no basis for that distinction, and many regulations on commerce do, in fact, impose penalties for failing to act. Moreover, those without health insurance scarcely abstain from commerce since they leave billions of dollars of unpaid bills at hospitals and other providers. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
COMMERCE CLAUSE APPLIES EVEN WITH INDIRECT INFLUENCE ON COMMERCE:

But their point fizzles legally. Under Supreme Court precedent, an effect on interstate commerce is enough to trigger regulation even if it is indirect and fortuitousin other words, the acts main motive is legally irrelevant. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
COMMERCE CLAUSE DOESNT MATTER, NECESSARY AND PROPER WORKS:

But the court could easily reverse the order of analysis. It could first observe that it is undisputed that the laws nondiscrimination provisions are valid exercises of Commerce Clause power, and then note that it is also undisputed that those provisions could not function without a mandate. This produces the clear conclusion that, whether or not the mandate is authorized by the Commerce Clause, it is constitutional under the Necessary and Proper Clause as reasonably necessary to stop insurers from discriminating. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
JUSTICE BLACK: INSURANCE IS JUST ANOTHER BUSINESS, BURDEN IS ON PRO:

Justice Black contended that a heavy burden is on him who asserts that the plenary power which the Commerce Clause grants to Congress to regulate Commerce among the several States does not include the power to regulate trading in insurance to the same extent that it includes power to regulate other trades or businesses conducted across state lines. BARNETT IN 2010 RANDY E. BARNETT, GEORGETOWN UNIVERSITY LAW CENTER. NEW YORK UNIVERSITY JOURNAL OF LAW AND LIBERTY. COMMANDEERING THE PEOPLE: WHY THE INDIVIDUAL HEALTH INSURANCE MANDATE IS UNCONSTITUTIONAL. http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1433&context=facpub&seiredir=1 ACCESSED: FEBRUARY 14, 2013
CONGRESS CAN REGULATE NON-COMMERCIAL ACTIVITY AND COMMERCIAL INACTIVITY:

Nor are the challengers correct that Congress can regulate only commercial activity. The Supreme Court has held since 1942 that Congress has Commerce Clause power to limit our ability to grow wheat that we consume ourselves and do not sell, reasoning that it suffices that this noncommercial activity encourages a commercial inactivity that in turn affects commerce because those who grow their own wheat are not buying wheat from others, which reduces commerce in wheat.1 If Congress can regulate a noncommercial activity that causes commercial inactivity that in turn affects commerce in this relatively minor way, then surely it can directly regulate a commercial inactivity that affects commerce in as major a way as the mandate would. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
FRAMERS UPHELD MULTIPLE MANDATES, INCLUDING ONE TO BUY INSURANCE:

Others argue that the Constitution's framers could not possibly have envisioned a congressional power to force purchases. However, in 1790, the first Congress, which was packed with framers, required all ship owners to provide medical insurance for seamen; in 1798, Congress also required seamen to buy hospital insurance for themselves. In 1792, Congress enacted a law mandating that all able-bodied citizens obtain a firearm. This history negates any claim that forcing the purchase of insurance or other products is unprecedented or contrary to any possible intention of the framers. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
MANDATE OKAY UNDER TAXING POWER:

Indeed, we already live under a mandate to buy health insurance, because we have to pay contributions to the Medicare trust fund. Some argue that Medicare contributions are a tax, not a forced purchase. But an obligation to pay money has the same effect whether we call it a tax or not. Indeed, the new mandate actually provides that one has to either buy health insurance or pay a tax. The penalty is similar in nature to, but usually much smaller in monetary value than, the higher taxes we have to pay if we don't get a home mortgage and therefore cannot deduct any mortgage interest from our taxes. The objectors respond that the new insurance mandate was not called a tax. But why should mere phrasing trump substance? Both Medicare and the new mandate entail obligations to pay money for health insurance. That is what matters, not the labels chosen to describe this reality. Because the objectors' taxnontax distinction turns only on phrasing, like their activityinactivity distinction, it similarly fails to prevent the feared power to force purchases. Even without Commerce Clause authority, Congress could achieve precisely the same result with its taxing power by requiring us to pay a tax whose revenue will go to buy health insurance or broccoli for ourselves. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
MANDATE NECESSARY AND PROPER TO UPHOLDING REST OF BILL:

Even if one did not want to recognize a Commerce Clause authority to force purchases, the mandate would remain constitutional under the Necessary and Proper Clause, because it is reasonably related to the ACA's provisions that prohibit discrimination against the sick, which are certainly permissible under the Commerce Clause. The reason is that without a mandate those provisions would encourage the healthy to put off buying insurance until they are sick, which could cause the health insurance market to collapse. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
MULTIPLE FOUNDING FATHERS PASSED A HEALTH INSURANCE MANDATE:

Six years later, in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. Thats right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams. ELHAUGE IN 2012 EINER ELHAUGE, J.D. PROFESSOR AT HARVARD LAW SCHOOL. THE NEW REPUBLIC. APRIL 13, 2012. IF HEALTH INSURANCE MANDATES ARE UNCONSTITUTIONAL, WHY DID THE FOUNDING FATHERS BACK THEM? http://www.newrepublic.com/article/politics/102620/individual-mandate-history-affordablecare-act# ACCESSED: FEBRUARY 17, 2013
NO HISTORICAL EVIDENCE THAT FRAMERS CONSIDERED MANDATES UNCONSTITUTIONAL:

Not only did most framers support these federal mandates to buy firearms and health insurance, but there is no evidence that any of the few framers who voted against these mandates ever objected on constitutional grounds. Presumably one would have done so if there was some unstated original understanding that such federal mandates were unconstitutional. Moreover, no one thought these past purchase mandates were problematic enough to challenge legally. ELHAUGE IN 2012 EINER ELHAUGE, J.D. PROFESSOR AT HARVARD LAW SCHOOL. THE NEW REPUBLIC. APRIL 13, 2012. IF HEALTH INSURANCE MANDATES ARE UNCONSTITUTIONAL, WHY DID THE FOUNDING FATHERS BACK THEM? http://www.newrepublic.com/article/politics/102620/individual-mandate-history-affordablecare-act# ACCESSED: FEBRUARY 17, 2013
FRAMERS MANDATES WERE MORE ONEROUS THAN HEALTH INSURANCE ONE:

One could argue that the laws for seamen and ship owners mandated purchases from people who were already engaged in some commerce. But that is no less true of everyone subject to the healthinsurance mandate: Indeed, virtually all of us get some health care every five years, and the few exceptions could hardly justify invalidating all applications of the statute. One could also argue (as the challengers did) that activity in the health care market isnt enough to justify a purchase mandate in the separate health insurance market. But the early mandates required shippers and seamen to buy health insurance without showing they were active in any market for health insurance or even health care, which was far more rare back then. ELHAUGE IN 2012 EINER ELHAUGE, J.D. PROFESSOR AT HARVARD LAW SCHOOL. THE NEW REPUBLIC. APRIL 13, 2012. IF HEALTH INSURANCE MANDATES ARE UNCONSTITUTIONAL, WHY DID THE FOUNDING FATHERS BACK THEM? http://www.newrepublic.com/article/politics/102620/individual-mandate-history-affordablecare-act# ACCESSED: FEBRUARY 17, 2013
FRAMERS MANDATES PROVE MANDATES ARE PROPER:

In oral arguments before the court two weeks ago, the challengers also argued that the health insurance mandate was not proper in a way that allows it to be justified under the Necessary and Proper Clause. These precedents rebut that claim because they indicate that the framers thought not just purchase mandates but medical insurance mandates were perfectly proper indeed. ELHAUGE IN 2012 EINER ELHAUGE, J.D. PROFESSOR AT HARVARD LAW SCHOOL. THE NEW REPUBLIC. APRIL 13, 2012. IF HEALTH INSURANCE MANDATES ARE UNCONSTITUTIONAL, WHY DID THE FOUNDING FATHERS BACK THEM? http://www.newrepublic.com/article/politics/102620/individual-mandate-history-affordablecare-act# ACCESSED: FEBRUARY 17, 2013
ADVERSE SELECTION:
WITHOUT MANDATE ADVERSE SELECTION RAISES PREMIUMS:

However, one of the most popular aspects of the ACA may encourage such adverse selection, since the law prohibits health insurers from discriminating against applicants on the basis of health, either by charging higher premiums for sick people or by excluding preexisting conditions from coverage. Absent other reforms, such regulations would theoretically increase premiums for healthy people and lead them to exit the non-group insurance market, which would cause premiums to rise even more. Informal support for this hypothesis comes from the fact that the five U.S. states with such regulations (known as community rating) are among the states with the highest non-group insurance premiums. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
MASSACHUSETTS PROVE MANDATE SOLVES ADVERSE SELECTION:

When the mandate became fully effective at the end of 2007, there was an enormous increase in the number of healthy enrollees and a far smaller bump in the enrollment of people with chronic illness. The gap then shrank to premandate levels as the remaining uninsured residents complied with the mandate, but clearly the mandate brought many more healthy people than nonhealthy ones into the risk pool. The large jump in healthy enrollees that occurred when the program became fully effective suggests that enrollment by the healthy was not simply slower than enrollment by the unhealthy, but rather that the mandate had a causal role in improving risk selection. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
MANDATE WILL BE EVEN MORE EFFECTIVE NATIONALLY THAN IN MASSACHUSETTS:

The larger subsidies in Massachusetts would be expected to have a greater effect in inducing healthy people to obtain insurance than the ACAs smaller subsidies which suggests that mandating coverage might well play an even larger role in encouraging the healthy to participate in health insurance markets nationally than it has in Massachusetts. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
ALTERNATIVES:
MANDATE IS BIPARTISAN:
I believe that there is a bipartisan consensus to have individual mandates, Senator Charles Grassley, the Iowa Republican, said in June 2009, while he was still dangling the possibility that hed vote for the bill. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
MANDATE KEY FOR PRIVATE-SECTOR BASED REFORM:

Many experts have long advocated a mandate as a central pillar of private-sectorbased health care reform. CHANDRA ET AL IN 2011 AMITABH CHANDRA, JONATHAN GRUBER AND ROBIN MCNIGHT, PhDs. NEW ENGLAND JOURNAL OF MEDICINE. JANUARY 27, 2011. THE IMPORTANCE OF THE INDIVIDUAL MANDATE EVIDENCE FROM MASSACHUSETTS. http://phes.co/Newengland/Ahmed/The%20Importance%20of%20the%20Individual%20Mandat e%20%E2%80%94%20Evidence%20from%20Massachusetts.pdf ACCESSED: FEBRUARY 25, 2013
PREFER MANDATED BENEFITS OVER UNIVERSAL CARE:

But even granting the equivalence, there should be at least some presumption in favor of mandated benefits. Mandated benefits preserve empoyers ability to tailor arrangements to their workers and to offer more than minimum packages Suppose that the government provides universal free health care of modest quality. This will be more attractive to many than paying the costs of high quality care themselves, even though if they had to pay for all their care, they would have selected high- rather than low-quality care. SUMMERS IN 1989 LARRY SUMMERS, HARVARD UNIVERSITY. THE AMERICAN ECONOMICS REVIEW, VOLUME 79 ISSUE 2. MAY 1989. SOME SIMPLE ECONOMICS OF MANDATED BENEFITS. http://faculty.washington.edu/romich/553/summers1989.pdf ACCESSED: MARCH 1, 2013
MANDATES HAVE LESS DEADWEIGHT LOSS THAN UNIVERSAL CARE PAID BY TAXES:
Another argument in favor of mandated benefits rather than public provisions is that mandated provision avoids the deadweight loss of tax-financed provision. Estimates of the marginal deadweight loss from a $1 increase in taxes range from the $1.07 suggested by Charles Stuart (1984) to the $1.21 suggested by Edgar Browning (1987) to the $1.33, as in Charles Ballard et al. (1985). These figures are probably underestimates since they recognize only a few of the many distortions caused by the tax system. This suggests that there are substantial efficiency gains to accomplishing social objectives in ways other than government taxation and provision Mandated benefits do not give rise to deadweight losses as large as those that arrive from government tax collections. SUMMERS IN 1989 LARRY SUMMERS, HARVARD UNIVERSITY. THE AMERICAN ECONOMICS REVIEW, VOLUME 79 ISSUE 2. MAY 1989. SOME SIMPLE ECONOMICS OF MANDATED BENEFITS. http://faculty.washington.edu/romich/553/summers1989.pdf ACCESSED: MARCH 1, 2013
COSTS:
UNINSURED PASS THEIR COSTS ON:

Because the uninsured often cannot afford the treatments they need, health-care providers will incur the resulting costs, either out of decency or legal duty, and then pass those costs on to taxpayers and the insured. Indeed, nearly two thirds of the costs of treating the uninsured are paid by others, with the total incurred by providers estimated by Congress to be $43 billion in 2008. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
UNINSURED USE EMERGENCY ROOM AS SOURCE OF CARE:

The uninsured are less likely to have a regular source of health care. 40% of the uninsured do not have a regular place to go when they are sick or need medical advice, compared to less than 10% of the insured. As a result, 20% of the uninsured say their usual source of care is the emergency room, compared to just 3% of the insured. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
INDIVIDUALS UNDERESTIMATE ECONOMIC VALUE OF INSURANCE:

When is there ever a case for mandating benefits or publicly providing goods that employers could provide their workers? Most obviously, there is the paternalism, or merit goods. Argument that individuals value certain services too little. They may irrationally underestimate the probability of catastrophic health expenses , or of a childs illness that would require a sustained leave A closely related argument involves the idea that society cares more about equal consumption of some merit good commodities than about others. SUMMERS IN 1989 LARRY SUMMERS, HARVARD UNIVERSITY. THE AMERICAN ECONOMICS REVIEW, VOLUME 79 ISSUE 2. MAY 1989. SOME SIMPLE ECONOMICS OF MANDATED BENEFITS. http://faculty.washington.edu/romich/553/summers1989.pdf ACCESSED: MARCH 1, 2013
POSITIVE EXTERNALITIES DEMAND MANDATED INSURANCE:

There are at least two further rationales for mandating benefits that do not assume individual irrationality. First, there may be positive externalities associated with the good externalities that cannot be captured by either the provider or the recipient. The most obvious example is health insurance. Society cares about preventing the spread of contagious diseases more than any individual does or would take account of. Further, people prefer for their friends and relatives to remain healthy, yet they cannot individually subsidize health insurance for all other consumers. SUMMERS IN 1989 LARRY SUMMERS, HARVARD UNIVERSITY. THE AMERICAN ECONOMICS REVIEW, VOLUME 79 ISSUE 2. MAY 1989. SOME SIMPLE ECONOMICS OF MANDATED BENEFITS. http://faculty.washington.edu/romich/553/summers1989.pdf ACCESSED: MARCH 1, 2013
UNINSURED USE OF E.R. COSTS BILLIONS ANNUALLY:

Unnecessary use of the ER: the ER is an expensive place to receive care. An average visit to an emergency room costs $383,11 whereas the average physicians office visit costs $60.12 It is estimated that 10.7% of ER visits in 2000 were for non-emergencies, costing the system billions of dollars. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURANCE = LONG-TERM DEVELOPMENTAL LOSSES FOR CHILDREN:

Developmental losses for children: children who are uninsured are more likely to suffer delays in development because of poor health, thus affecting their future earning capacity. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED LACK OF PARTICIPATION IN WORKFORCE COSTS 130 BIL ANNUALLY:

Fewer years of participation in the workforce: The annual cost of diminished health and shorter life spans of Americans without insurance is $65-$130 billion. People who do not live as long do not work and contribute to the economy as long. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED DRAIN 60% OF EMPLOYER-PROVIDED HEALTH INSURANCE:

Much more important is the externality that arises from societys unwillingness or inability to deny care completely to those in desperate need, even if they cannot pay. The Congressional Budget Office estimates that there are 23 million American employees without health insurance. Health insurance for this group would cost about $25 billion. Currently, these uninsured employees occur about $15 billion in health care costs for which they do not pay. The costs are borne in part by the physicians and other providers of health care, but most of the cost is passed on to other consumers in the form of higher insurance and medical costs. The externality here is quite large. About 60% of the benefit of employer-provided health insurance accrues ultimately to neither employer nor employee. Even with the current tax subsidy to employer-provided health insurance, there might be a further case for government action. SUMMERS IN 1989 LARRY SUMMERS, HARVARD UNIVERSITY. THE AMERICAN ECONOMICS REVIEW, VOLUME 79 ISSUE 2. MAY 1989. SOME SIMPLE ECONOMICS OF MANDATED BENEFITS. http://faculty.washington.edu/romich/553/summers1989.pdf ACCESSED: MARCH 1, 2013
NO EVIDENCE IN MASSACHUSETTS THAT MANDATE INCREASED COST OF HOSPITAL CARE:

Increased coverage aected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. We also nd evidence that outpatient care reduced hospitalizations for preventable conditions. At the same time we nd no evidence that the cost of hospital care increased. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
MASSACHUSETTS SHOWS MANDATE LOWERS COSTS FOR EVERYONE:

We also nd evidence for declines in the intensity of treatment and weaker evidence for declines in prices paid by private payers. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
EMPLOYERS CANT COVER EMPLOYEES ANYMORE:

In the face of rising health care costs, fewer employers are able to provide their workers with health insurance; the percentage of employers offering health insurance dropped from 69% in 2000 to 60% in 2005. Even if employers are able to provide health insurance benefits, the trend is towards providing high-deductible insurance that covers an ever-shrinking percentage of health care costs. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
ACCESS:
INSURANCE INCREASES ACCESS AND REDUCES COSTS:

Medicaid does seem to provide access to care. Persons on Medicaid also receive more medical treatment, as indicated by the number of prescription drugs they are taking Medicaid recipients take significantly more prescription drugs than others, even with adjustment for their poorer health. With adjustment for health, all types of insurance significantly reduce difficulties paying for medical care. Compared with the uninsured, persons covered by Medicaid, Medicare, and private insurance report significantly less trouble paying for medical care. This appears to be the largest, most consistently positive effect of medical insurance. ROSS AND MIROWSKY IN 2000 CATHERINE ROSS AND JOHN MIROWSKY, THE OHIO STATE UNIVERSITY. THE MILBANK QUARTERLY, VOLUME 8 NUMBER 2. 2000. DOES MEDICAL INSURANCE CONTRIBUTE TO SOCIOECONOMIC DIFFERENTIALS IN HEALTH? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751153/pdf/milq_171.pdf ACCESSED: MARCH 1, 2013
MANDATE DECREASES UNINSURANCE:

We nd that the reform increased insurance coverage among the general and inpatient hospital populations. Among the population of hospital discharges in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
INCREASED INSURANCE = INCREASED MEDICAL CARE:

Groups with bigger increases in coverage at 65 experience bigger reductions in the probability of delaying or not receiving medical care, and bigger increases in the probability of routine doctor visits. Hospital discharge records also show large increases in admission rates at age 65, especially for elective procedures like bypass surgery and joint replacement. CARD ET AL IN 2004 DAVID CARD, CARLOS DOBKIN, AND NICOLE MAESTAS. NATIONAL BUREAU OF ECONOMIC RESEARCH, WORKING PAPER NO. 10635. MARCH 2004. THE IMPACT OF NEARLY UNIVERSAL INSURANCE COVERAGE ON HEALTH CARE UTILIZATION AND HEALTH. http://www.nber.org/papers/w10365 ACCESSED: MARCH 1, 2013
MORALITY:
MANDATE KEY TO STOPPING DISCRIMINATION:

The central purpose was that, without the mandate, other provisions that prohibit discriminating against sick people by denying coverage or charging higher rates would encourage healthy people to put off buying insurance until they get sick. If this were to happen, premiums would go up and the insured pool would get sicker, until the market collapsed. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
MANDATE KEY TO PERSONAL RESPONSIBILITY:

A decade later, personal responsibility was the core of the case for the individual mandate that Governor Romney made in Massachusetts. Its the ultimate conservative idea, which is that people have responsibility for their own care, and they dont look to government ... if they can afford to take care of themselves, he told reporters when he released his proposal in June 2005. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
ACCESS TO HEALTHCARE KEY TO OPPORTUNITY AND THEREFORE JUSTICE:

The central moral importance, for purposes of justice, of preventing and treating disease and disability with effective healthcare services (construed broadly to include public health and environmental measures, as well as personal medical services) derives from the way in which protecting normal functioning contributes to protecting opportunity. Specifically, by keeping people close to normal functioning, healthcare preserves for people the ability to participate in the political, social, and economic life of their society. It sustains them as fully participating citizens normal collaborators and competitorsin all spheres of social life. DANIELS IN 2001 NORMAN DANIELS, PROFESSOR OF ETHICS AT HARVARD SCHOOL OF PUBLIC HEALTH. THE AMERICAN JOURNAL OF BIOETHICS, VOL 1 NO 2. JUSTICE, HEALTH, AND HEALTHCARE http://www.ncbi.nlm.nih.gov/pubmed/11951872 ACCESSED: FEBRUARY 18, 2013
UNIVERSAL ACCESS TO INSURANCE KEY TO JUSTICE:

The account sketched here has several implications for the design of our healthcare institutions and for issues of resource allocation. Perhaps most important, the account supports the provision of universal access to appropriate healthcareincluding traditional public health and preventive measures through public or mixed public and private insurance schemes. Healthcare aimed at protecting fair equality of opportunity should not be distributed according to ability to pay, and theburden of payment should not fall disproportionately on the ill (Daniels 1985, 1995; and Daniels, Light, and Caplan 1996). DANIELS IN 2001 NORMAN DANIELS, PROFESSOR OF ETHICS AT HARVARD SCHOOL OF PUBLIC HEALTH. THE AMERICAN JOURNAL OF BIOETHICS, VOL 1 NO 2. JUSTICE, HEALTH, AND HEALTHCARE http://www.ncbi.nlm.nih.gov/pubmed/11951872 ACCESSED: FEBRUARY 18, 2013
INCREASING INSURANCE DECREASES HEALTH DISPARITIES:

We use the increases in health insurance coverage at age 65 generated by the rules of the Medicare program to evaluate the effects of health insurance coverage on health related behaviors and outcomes. The rise in overall coverage at age 65 is accompanied by a narrowing of disparities across race and education groups. CARD ET AL IN 2004 DAVID CARD, CARLOS DOBKIN, AND NICOLE MAESTAS. NATIONAL BUREAU OF ECONOMIC RESEARCH, WORKING PAPER NO. 10635. MARCH 2004. THE IMPACT OF NEARLY UNIVERSAL INSURANCE COVERAGE ON HEALTH CARE UTILIZATION AND HEALTH. http://www.nber.org/papers/w10365 ACCESSED: MARCH 1, 2013
MANDATE REDUCES RACIAL DISPARITIES IN ACCESS TO HEALTH CARE:

Finally, we examine heterogeneity in coverage and outcomes by race in Tables 10 and 11. From the means in the bottom rows of each cell, we can see that whites had the highest levels of insurance coverage before the reform. In percentage point terms, all races experienced gains in coverage, but people identied as black, Hispanic, or of unknown race, experienced the largest increases in coverage through the reform. Medicaid expansions were also largest among these groups. Native Americans, which make up less than one percent of the population, experienced the largest gains in private coverage. People of all races took up coverage through CommCare at varying rates. The reform reduced disparities in coverage by race, but it did not eliminate them. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
LIVES:
UNINSURED LESS LIKELY TO BE ABLE TO FULFILL PRESCRIPTIONS:

The uninsured are less likely to be able to fill prescriptions and more likely to pay much more of their money out-of-pocket for prescriptions. In a recent survey, one third of uninsured Americans reported that they were unable to fill a prescription drug in the last year because of the cost. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED POSTPONE OR DONT GET CARE:

The uninsured are 3-4 times more likely than those with insurance to report problems getting needed medical care, even for serious conditions. In one study, more than half of the uninsured postponed needed medical care due to financial concerns, while over one third went without a physician-recommended medical test or treatment due to financial concerns. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED MORE LIKELY TO GET LATE DIAGNOSES FOR CANCER:

The uninsured are more likely to be forced to delay medical services, affecting the timeline of diagnosis and thus the prognosis of the disease process. In one study, the time to diagnosis of latestage cancer was compared between uninsured and privately insured patients. The uninsured patients were 1.7, 2.6, 1.4, and 1.5 times more likely to be diagnosed late for colorectal cancer, melanoma, breast cancer, and prostate cancer, respectively. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED ARE 50% LESS LIKELY TO GET PREVENTATIVE CARE:

The uninsured are less likely to get needed preventive care. When compared to the insured, uninsured, non-elderly adults are 50% less likely to receive preventive care such as pap smears, mammograms, blood pressure checks, sigmoidoscopies, cholesterol screening, and prostate exams. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
UNINSURED LESS LIKELY TO GET GOOD CARE FOR CHRONIC DISEASES LIKE LIVER DISEASE OR DIABETES:
The uninsured are more likely to receive poor care for chronic diseases. Among nonelderly adult diabetics, a lack of insurance is associated with less glucose monitoring and fewer foot and eye exams, leading to an increased risk of hospitalization and disability. Uninsured individuals with end-stage renal disease are more likely to have progressed to a more advanced stage before beginning dialysis. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
BEING UNINSURED IS AS DEADLY AS DIABETES, STROKES, HIV, AND HOMICIDES:

This increased mortality translates into 18,000 excess deaths for people between age 25-64 per year, which is of comparable magnitude to the number of people in this age group who die each year from diabetes, stroke, HIV, and homicide. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
275,000 LIVES LOST IN THE NEXT DECADE DUE TO NO INSURANCE:

As members of the Obama administration and Congress met on Thursday to try to find common ground on health care, a new report warned that without comprehensive legislation, more than 275,000 adults nationwide will die over the next decade because of a lack of health insurance. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
UNINSURED INCREASE DISEASE BURDEN AMONG COMMUNITIES:

Adverse effects on public health: Communities with high rates of uninsurance have less effective control of communicable disease (e.g. less vaccinations, less surveillance of TB) and an overall greater disease burden in general. Furthermore, public health agencies may have budgetary problems if the local government has to siphon dollars away to pay for safety net services for the uninsured. CHUA AND CASOY IN 2008 KAO-PING CHUA AND FLAVIO CASOY, AMERICAN MEDICAL STUDENT ASSOCIATION. NO DATE. THE CASE FOR UNIVERSAL HEALTHCARE. http://www.amsa.org/AMSA/Libraries/Committee_Docs/CaseForUHC.sflb.ashx ACCESSED: FEBRUARY 26, 2013
68 TO 84 DEATHS DAILY DUE TO UNINSURANCE:

The new report estimates that currently 68 adults under age 65 die every day because they dont have coverage. Absent a significant change in coverage, the figure will climb to 84 by 2019, the study projects. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
WARRANT LEADING FROM UNINSURNACE TO DEATH:

A growing body of research has explored the connection between a lack of health insurance and an increased risk of death. Uninsured people are more likely to skip screenings and other preventive care, so their medical problems are often diagnosed later, when they are more advanced and tougher to treat. The uninsured are also more likely to skimp on necessary medical care, whether its prescription drugs to keep their blood pressure in check or surgery to clear up clogged arteries. The bottom line is that if you dont get a disease picked up early and you dont get necessary treatment, youre more likely to die, said Stan Dorn, a senior fellow at the Urban Institute and the author of the organizations earlier study. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
CHILDREN WITHOUT INSURANCE 60% MORE LIKELY TO DIE:

In addition, these numbers dont include children. Children are generally very healthy, and many are eligible for coverage under public programs like the state Childrens Health Insurance Program. But many children arent enrolled in Medicaid or other programs for which theyre eligible. According to research cited in the Families USA study, hospital mortality rates were 60 percent higher for children without insurance. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
300,000 HAVE DIED DUE TO NO INSURANCE SINCE 1995:

In addition to projecting premature deaths, the new study estimated the number of people who had died since the last major push for health care legislation in the early 1990s. It found that between 1995 and 2009, lack of insurance was responsible for more than 290,000 premature deaths. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
STUDY SAYING 68 DEATHS DAILY IS LIKELY CONSERVATIVE:

Experts say that the new studys estimates of premature death likely err on the conservative side. The report calculated that lack of insurance increased mortality rates by 25 percent. But research conducted using more recent data found that not having insurance increases death rates by 40 percent. ANDREWS IN 2010 MICHELLE ANDREWS, THE NEW YORK TIMES PRESCRIPTIONS BLOG. FEBRUARY 26, 2010. DEATHS RISING FOR LACK OF INSURANCE, STUDY FINDS. http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurancestudy-finds/ ACCESSED: MARCH 1, 2013
GETTING INSURANCE = HEALTH GAINS:

Finally, there are small impacts of reaching age 65 on self-reported health, with the largest gains among the groups that experience the largest gains in insurance coverage. CARD ET AL IN 2004 DAVID CARD, CARLOS DOBKIN, AND NICOLE MAESTAS. NATIONAL BUREAU OF ECONOMIC RESEARCH, WORKING PAPER NO. 10635. MARCH 2004. THE IMPACT OF NEARLY UNIVERSAL INSURANCE COVERAGE ON HEALTH CARE UTILIZATION AND HEALTH. http://www.nber.org/papers/w10365 ACCESSED: MARCH 1, 2013
STUDIES THAT ARE DESIGNED WELL SHOW BENEFITS OF INSURANCE:

The quality of research has improved significantly, as investigators have employed quasiexperimental designs with increasing frequency to address limitations of earlier research. Recent studies have found consistently positive and often significant effects of health insurance coverage on health across a range of outcomes. In particular, significant benefits of coverage have now been robustly demonstrated for adults with acute or chronic conditions for which there are effective treatments. MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
MCWILLIAMS LITERATURE REVIEW IS OF 42 STUDIES:

After applying these inclusion criteria to the studies identified in literature searches, I selected forty-two studies for systematic review (these studies, listed in the references, are marked by an asterisk). MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
REVIEW OF 42 STUDIES FINDS CONSISTENT POSITIVE EFFECTS OF INSURANCE ON HEALTH:

These studies have found consistently positive and often significant effects of health insurance on health across a range of outcomes (see Table 1), thereby bolstering the general conclusions of the Institute of Medicine's 2002 report. MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
HEALTH INSURANCE SHOWN TO BE GOOD FOR A RANGE OF DISEASES:

Nevertheless, these important strides in research quality have strengthened the evidence that uninsurance adversely affects health, thereby allowing conclusions to be more definitive. Significant health benefits of health insurance coverage have now been robustly demonstrated for adults across a range of chronic and acute conditions, including hypertension, coronary heart disease, congestive heart failure, cerebrovascular disease, diabetes, HIV infection, depressive symptoms, acute myocardial infarction, acute respiratory conditions, and other acute conditions. MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
HEALTH INSURANCE POSITIVELY CORRELLATED WITH PREVENTATIVE CARE:

For example, several studies have demonstrated robustly that health insurance coverage increases the use of important screening and preventive services, but the receipt of these services may not pay dividends in mortality or quality of life for years or even decades. MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
ANSWERS-T0:
A/T OVERUTILIZATION:
Moreover, the greater use of inappropriate care among adults with more extensive coverage (Newhouse 1993) reflects deficiencies in coverage design and the delivery system, not in insurance status per se, and so should be addressed accordingly. MCWILLIAMS IN 2009 J. MICHAEL MCWILLIAMS, HARVARD MEDICAL SCHOOL. MILBANK QUARTERLY, VOLUME 87, NUMBER 2. JUNE 2009. HEALTH CONSEQUENCES OF UNINSURANCE AMONG ADULTS IN THE UNITED STATES. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/ ACCESSED: MARCH 1, 2013
A/T OVERUTILIZATION/MORAL HAZARD:

The problem with the theory of moral hazard as applied to health care is that there are few experiences less pleasant than going to the doctor. "Do your patients like going to the doctor?" I asked a physician seated next to me at a dinner before the debate. "Of course not," he said. "They go because their wives tell them to." (He didn't explain what motivates wives to go to the doctor.) The availability of health care to a potential patient is different from the availability of, say, federal bailout money to an investment bank. Getting rich off an investment with minimal downside risk is fun. Having your doctor poke his index finger up your rectum is not fun. NOAH IN 2010 TIMOTHY NOAH, STAFFER, SLATE MAGAZINE. FEBRUARY 3, 2010. HEALTH REFORM AND MORAL HAZARD. http://www.slate.com/articles/news_and_politics/prescriptions/2010/02/health_reform_and_mo ral_hazard.html ACCESSED: MARCH 2, 2013
A/T EVERYONE WILL GO ONTO PUBLIC INSURANCE:

We see some evidence of crowd out of private coverage by subsidized coverage for the hospitalized population but we do not nd evidence for crowd out in the general population, suggesting the incidence of crowd out is not uniform. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
A/T MANDATE INCREASES HEALTH CARE OVERUTILIZATION:

Increased coverage aected utilization patterns by decreasing length of stay and the number of inpatient admissions originating from the emergency room. We also nd evidence that outpatient care reduced hospitalizations for preventable conditions. KOLSTAD AND KOWALSKI IN 2010 JONATHAN KOLSTAD, UNIVERSITY OF PENNSYLVANIA, AND AMANDA KOWALSKI, YALE UNIVERSITY AND NATIONAL BUREAU OF ECONOMIC RESEARCH. JUNE 3, 2010. THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE: EVIDENCE FROM MASSACHUSETTS. http://www.hec.unil.ch/documents/seminars/iems/319.pdf ACCESSED: MARCH 3, 2013
A/T SLIPPERY SLOPE:

For their part, defenders of the mandate have advanced their own slippery slope scenarios, claiming that a decision striking down the mandate would imperil major Supreme Court federalism precedents, restore the much-reviled Lochner v. New York, and prevent Congress from enacting potentially vital regulatory legislation in the future. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
A/T LEGAL SLIPPERY SLOPE IS DANGEROUS:

Many slippery slope arguments proceed on the assumption that the lack of a logical distinction between A and B is enough to prove that a serious danger exists. However, this is not always true. Even if B logically flows from A, future judges might nonetheless reject B even at the cost of logical contradiction.10 In addition, to the extent that a decision upholding B requires the enactment of new statutes by the legislature, it might not happen because political constraints prevent such enactments from occurring. For these reasons, a logical slippery slope does not necessarily pose a severe danger in and of itself. SOMIN IN 2012 ILYA SOMIN, ASSOCIATE PROFESSOR AT GEORGE MASON UNIVERSITY SCHOOL OF LAW. LAW AND CONTEMPORARY PROBLEMS, VOLUME 75, P. 75. A MANDATE FOR MANDATES: IS THE INDIVIDUAL HEALTH INSURANCE CASE A SLIPPERY SLOPE? http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1678&context=lcp& ACCESSED: MARCH 3, 2013
A/T GUN MANDATE WAS UNDER MILITIA POWER:

Nor do any of these attempted distinctions explain away the mandate to buy guns, which was not limited to persons engaged in commerce. One might try the different distinction that the gun purchase mandate was adopted under the militia clause rather than the commerce clause. But that misses the point: This precedent (like the others) disproves the challengers claim that the framers had some general unspoken understanding against purchase mandates. ELHAUGE IN 2012 EINER ELHAUGE, J.D. PROFESSOR AT HARVARD LAW SCHOOL. THE NEW REPUBLIC. APRIL 13, 2012. IF HEALTH INSURANCE MANDATES ARE UNCONSTITUTIONAL, WHY DID THE FOUNDING FATHERS BACK THEM? http://www.newrepublic.com/article/politics/102620/individual-mandate-history-affordablecare-act# ACCESSED: FEBRUARY 17, 2013
A/T UNCONSTITUTIONAL BECAUSE ITS A PRIVATE PURCHASE:

Some argue that Medicare differs from the mandate because Medicare forces us to buy health insurance from the government, rather than from private insurers. But any concern about Congress forcing us to buy broccoli would hardly seem lessened if it further limited our options by requiring us to buy that broccoli from government stores. Moreover, Medicare actually allows beneficiaries to get their benefits through private insurers. So this argument collapses to the claim that the government could force us to buy health insurance only if it also gives us the option of selecting government insurance. It's hard to see how this claim addresses any concern about limiting Congress's power to force purchases. ELHAUGE IN 2012 EINER ELHAUGE, J.D. THE NEW ENGLAND JOURNAL OF MEDICINE, JANUARY 5, 2012. THE IRRELEVANCE OF THE BROCCOLI ARGUMENT AGAINST THE INSURANCE MANDATE. http://www.nejm.org/doi/full/10.1056/NEJMp1113618 ACCESSED: FEBRUARY 17, 2013
A/T INSURERS LOBBYING PUT THE MANDATE INTO THE LAW:

WHY WERE DEMOCRATS so determined to make the mandate part of the law in the first place? According to a view popular on the left, the main factor was the insurance industry, which wanted millions of additional customers. There was a grain of truth to this: As Ignagni made clear in Chicago in 2008, the industry did want a mandate, and, in the early stages of the reform battle, Democrats hoped to get the industrys support. But, in the end, Ignagnis group refrained from endorsing the Affordable Care Act, and the Big Five commercial insurers poured money into the U.S. Chamber of Commerce to fight it. If insurance-industry pressure were the sole or main impetus, the mandate might not have made it into the final bill. STARR IN 2011 DR. PAUL STARR, PROFESSOR OF SOCIOLOGY AT PRINCETON UNIVERSITY. THE NEW REPUBLIC. DECEMBER 14, 2011. THE MANDATE MISCALCULATION. http://www.newrepublic.com/article/politics/magazine/98554/individual-mandate-affordablecare-act# ACCESSED: FEBRUARY 12, 2013
A/T INACTIVITY CANT BE REGULATED:

The premise of the overall constitutional challenge is that the federal government cannot regulate commercial inactivity. In other words, Congress may be able to regulate our commercial conduct, but it cant force us to engage in commerce, such as by making us buy ordinary products like broccoli or GM cars or, for that matter, health insurance. In fact, this premise is flawed. No constitutional text, history, or precedent has ever indicated that Congress could not regulate commercial inactivity. To the contrary, there are plenty of examples, going back to the very first Congress, where Congress has required us to engage in commercial activityincluding making us buy health insurance. ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013
A/T VERY SMALL HEALTH INSURANCE ACTIVITY:

They argue that the amount of cost-shifting caused by the uninsured is smaller than Congresss $43 billion figure. Many of their objections are economically powerful, but legally their effort falls flat because even they concede that the shifted costs are at least $12.8 billion, and the court has upheld federal laws based on far more trivial effects on interstate commerce. Moreover, in the end, the numbers dont matter: No one disputes that Congress may regulate commercial activity regardless of whether it imposes costs on others. So even if uninsured people cost us nothing, they are still active in the health-care markets, and the opposing brief does not really deny this (even though it quibbles about the precise extent to which that activity is unavoidable). ELHAUGE IN 2012 EINER ELHAUGE, J.D., HARVARD SCHOOL OF LAW,, THE DAILY BEAST. MARCH 25, 2012. ECONOMISTS ARGUE OVER THE COST OF CARING FOR THE UNINSURED. http://www.thedailybeast.com/articles/2012/03/25/economists-argue-over-the-cost-of-caringfor-the-uninsured.html ACCESSED: FEBRUARY 15, 2013

Syke Files - March 2013

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Syke Files - March 2013

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MARCH 2013 RESOLVED: THE UNITED STATES SHOULD NOT REQUIRE ITS CITIZENS TO HAVE HEALTH INSURANCE VOLUME

DEFINITION OF REQUIRED TO HAVE INSURANCE

MANDATE IN OBAMACARE IS RESOLUTIONAL:

MANDATE IS A RESULT OF LOBBYING, GIFT TO INSURANCE COMPANIES:

EMPLOYER MANDATE IS BAD TOO:

JUST TAX PEOPLE:

LET STATES FIGURE IT OUT:

MANDATE ONLY WORKS AS A COMPLEMENT TO A COMPLETE OVERHAUL:

PEOPLE WONT COMPLY WITH ILLEGITIMATE, UNENFORCABLE LAWS:

AUTO INSURANCE PROVES COMPLIANCE IS EMPIRICALLY LOW:

ORIGINALISM DICTATES INSURANCE IS NOT COMMERCE:

CONGRESS HAS NO COMMERCE GROUNDS ON WHICH TO TOUCH INSURANCE:

MANDATE IS UNCONSTITUTIONAL INDEPENDENT OF COMMERCE CLAUSE:

MANDATE ISNT A TAX:

DANGERS OF ACCEPTING MANDATE AS A TAX:

ONLY ACCEPTABLE MANDATES ARE THOSE NECESSARY TO THE EXISTENCE OF GOVERNMENT:

NEITHER NECESSARY NOR PROPER, EXPLODES LIMITS ON POWERS:

MANDATE DOESNT REDUCE PREMIUMS OF THE INSURED:

UNINSURED ARE THAT WAY DUE TO COSTS, NOT CHEATING:

MANDATE DOES NOTHING TO MAKE CARE MORE AFFORDABLE:

HIGH COSTS KEY TO CONTROLLING OVERSPENDING BY PATIENTS:

PATIENTS FEELING COSTS KEY TO REFORMING HEALTHCARE, MANDATE SHIELDS:

MANDATES INCREASE PREMIUMS:

MIDDLE-CLASS FAMILIES CANT AFFORD INSURANCE:

UNINSURED WOULD USE AN ADDITIONAL $69 BILLION IN CARE:

ONLY 20% OF CURRENTLY UNINSURED CAN AFFORD TO BUY INSURANCE:

UNINSUREDS SPENDING WOULD SHIFT TO THE GOVERNMENT:

WOULD HAVE TO COVER THE COSTS OF CURRENTLY UNCOMPENSATED CARE:

HAVING INSURANCE DOESNT SOLVE FREE RIDING:

UNINSURED PAY FOR A LOT OF THEIR CARE:

FREE RIDING IS ONLY WORTH 3% OF HEALTHCARE EXPENDITURES:

MANDATE SUBJECT TO INTENSE REGULATION:

OVERREGULATION DUE TO MANDATE CUTS OFF HEALTHCARE INNOVATION AT THE KNEES:

OVERREGULATION INCREASES COSTS, IMPACT IS LESS ACCESS:

MANDATE A SLIPPERY SLOPE TO OVERREGULATION:

MEDICAID CANT HANDLE THE INCREASED LOAD:

PUBLIC INSURANCE ASSOCIATED WITH NEGATIVE HEALTH OUTCOMES:

PUBLIC INSURANCE USES INEFFECTIVE MEASURES, LEADING TO BAD HEALTH OUTCOMES:

LOBBYING WILL EXPLODE THE MINIMUM BENEFITS, RAISING PRICES:

MASSIVE INCREASE IN MANDATED BENEFITS INEVITABLE:

STATES EMPIRICALLY PROVE THAT MANDATED BENEFITS WILL EXPLODE:

MEDICARE PROVES LOBBYING INCREASES MANDATED BENEFITS:

INCREASING MANDATED BENEFITS INCREASES PREMIUMS 20 TO 50 PERCENT:

GAINING INSURANCE DOESNT HAVE A SIGNIFICANT EFFECT ON SAVING LIVES:

POLSKY STUDY ON MEDICARE TRANSLATES TO A GENERAL VIEW OF PROVIDING INSURANCE TO UNINSURED:

EVEN PRIVATE INSURANCE DOESNT IMPROVE HEALTH OUTCOMES SIGNIFICANTLY:

INSURANCE IS POSITIVELY CORRELATED TO OBESITY:

CHANGES MIGHT LEAD TO INCREASED HEALTH CARE USE AMONG ALREADY-INSURED:

THOSE ON PUBLIC INSURANCE USE SIGNIFCANTLY MORE RESOURCES THAN UNINSURED:

LEGAL SLIPPERY SLOPES EXIST, NOT A FALLACY:

MANDATE IS A CLEAR LOGICAL SLIPPERY SLOPE:

CONGRESS WILL ABUSE ITS NEW POWERS:

STRIKING DOWN MANDATE DOESNT CREATE A SLIPPERY SLOPE:

A/T MANDATE KEY TO UNIVERSAL COVERAGE:

A/T MASSACHUSSETTS AS AN EXAMPLE:

A/T FREE RIDERS JACK UP EVERYONE ELSES PREMIUMS:

A/T NEED MANDATE TO SOLVE DISCRIM/ADVERSE SELECTION:

A/T STATES WITH COMMUNITY RATING HAVE HIGH PREMIUMS:

A/T UNINSURED BANKRUPTCIES:

A/T HAVING INSURANCE WILL SOLVE FOR BANKRUPTCIES:

A/T MCWILLIAMS STUDY:

A/T REDUCES RACIAL DISPARITIES:

DEFINITION OF REQUIRED TO HAVE INSURANCE

MANDATE IN OBAMACARE IS RESOLUTIONAL: