One of the talking points in the political promotion of the Affordable Care Act (ACA) also known as Obamacare was the attempt to provide health insurance to the vast majority of the estimated 45 million uninsured Americans. Arguments about the ability of an overburdened health-care system to absorb upwards of 45 million more potential patients is a particularly interesting argument. The specter of rationing when price is eliminated as the rationing agent [price fixing scheme of Obamacare and the subsequent outcomes of price fixing schemes] and other arguments regarding the scheme’s viability and implementation are very valid arguments regarding the absorption of upward of 45 million new participants.
However, will in fact upward of 45 million people become insured or will the number be much, much smaller?
Putting aside arguments that the current number of insured(s) may actually fall and concentrating on the potential 45 million additional insured(s), will in fact the 45 million become a much, much smaller number than anticipated due to the “penalty” of the individual mandate being depicted as a “tax” by SCOTUS?
Thomas Lambert, law professor from the University of Missouri in an assay entitled How the Supreme Court Doomed the ACA to Failure explains at length why the Obamacare fine/penalty/tax is much more rational to pay than acquiring coverage. That is, Lambert puts forth the formula of rationally paying the tax and acquiring coverage only when a sickness, illness or accident manifests itself and/or occurs.
More importantly Lambert explains the reasoning behind Justice Roberts conclusion that the penalty was a tax and how the tax has to be relatively small in size (not punitive) and how the tax must remain the same amount adjusted for inflation. That is, the “tax” can not be increased per the Roberts decision except via an inflation adjustment which means the tax remains relative in size to the inflation adjusted Obamacare insurance premium. Therefore, the tax remains relative and hence it will always be rational to follow the Lambert formula of paying the tax and acquiring coverage only as needed. The only exception to the formula is if health-care prices fall, but Obamacare does precious little to address the underlying health-care price.
Lambert also points out that the framers/promoters of ACA likely figured they, in the future, could increase the penalty/tax via congress. Problem is the same framers/promoters never figured on the individual mandate and associated penalty being framed constitutional via a “tax” argument and hence made no process arrangements for raising the penalty aka “tax”. Hence no mechanism exists in ACA to raise the tax as that was something the framers/promoters would have gotten around to later but now can not make any changes at all due to Roberts decision and the requirement that the tax can not change except adjustments for inflation. Ops!
With the formula in hand and with the rational response being to pay the fine and acquire coverage when necessary, anti-selection sets in, in a big way, with only older and infirmed individuals buying coverage which means health insurance premiums skyrocket. Given the Lambert formula via the tax depiction by Roberts, the mantra of upwards of 45 million new insured(s) fizzles.
Thomas Lambert’s entire essay can be found in the link below: