photos by congress.org and SEIU International

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Do Now

Should we be required to have health insurance? Why or why not? What could be beneficial or problematic in either case?

Intro

There is intense debate over the Patient Protection and Affordable Care Act which President Obama signed into law on March 23, 2010, to put in place comprehensive health insurance reforms which will roll out over the next four years with most changes taking place by 2014. The law has been vehemently challenged and on March 29th this year, the Supreme Court finished hearing three days of arguments about the constitutionality of that law. One of the key issues at stake is what is termed the individual mandate.

The debate hinges on whether the U.S. government can oblige all citizens to have health insurance. It is presented as an argument about government involvement and individual liberty – that is whether the government can require us to buy health insurance coverage or not, with the proviso that those who choose not to purchase health insurance will be required to pay a fee.

It is such a key issue that, when the Supreme Court rules in June, the fate of the entire law's other 450 or so sections could be struck down as a result of findings on the constitutionality of this issue.

The justices in the court offered arguments on both sides of this debate.

Justice Ruth Bader Ginsburg, in support of the law: "Those who don't participate in health care make it more expensive for everyone else"… "It is not your free choice."

On the other side: Justice Anthony Kennedy argued that the federal government "is telling an individual he has the obligation he must act" and purchase insurance. "That threatens to change the relationship between the government and the individual in a profound way."

Justice Antonin Scalia argued "It may well be that everybody needs health care sooner or later, but not everybody needs a heart transplant, not everybody needs a liver transplant,"… "Could you define the market so that everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli?"

There are other key provisions in this law. For example:

• Insurance companies will not be able to deny health coverage to children or adults with pre-existing conditions.
• The law includes a huge expansion of Medicaid, the joint federal-state program for people with low incomes.
• The legislation will add roughly 16 million people to the 60 million or so people on the program now.
• The law provides nearly $11 billion over 5 years to expand community health centers, which also serve people with low incomes and people without insurance.

Even though this law is expected to dramatically expand the number of people with insurance, there will still be millions of people who will remain uninsured, including undocumented immigrants who aren't eligible for any assistance and others who are exempt from the mandate.

What do you think? Check out the arguments in the resources section.

Resource

KQED Forum segment Health Law Hearings Wrap-Up - March 29, 2012
The U.S. Supreme Court has wrapped up three days of hearings on the federal health care overhaul. While the White House believes the health care law will be upheld, some analysts think the justices have signaled they are prepared to invalidate the individual mandate, which could put the entire law at risk.

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More Resources for Follow-up Lessons

KQED California Report's State of Health blog post The Medicaid Expansion in California: Analysis & Reaction - March 28, 2012 -- As part of the health care overhaul, the government will dramatically expand Medicaid -- the federal health care program for the poor. California is slated to get billions in federal funds ... if the Medicaid expansion holds up in Court.

KQED California Report's State of Health blog post Justices Tackle The Big Question: Can Congress Force You To Buy Insurance? - March 27, 2012 -- The Supreme Court is taking up the key question in the challenge to President Barack Obama’s historic health care overhaul: Can the government force people to carry insurance or pay a penalty?

KQED California Report's State of Health blog post Without Individual Mandate, Fewer Californians with Health Insurance - Jan. 26, 2012 -- In March, the U.S. Supreme Court will consider the constitutionality of several aspects of health care reform, including the “individual mandate,” the requirement that all Americans have health insurance.