Government lawyers say Obamacare will fall into a death spiral if the Supreme Court strikes down the provision in the Affordable Care Act requiring everyone to carry health insurance. Without the individual mandate, they say, some healthy people will forgo insurance to save money. That will force insurers to raise premiums on everyone else, the argument goes, which will prompt even more people to drop out until only the sickest remain.
Judging from the skeptical questions posed by the justices this week, it’s possible the mandate will die. If it does, there will be some serious scrambling for another way to preserve the health-care law’s two key protections: the right of everyone to be insured and the prohibition against charging people extra for costly preexisting conditions.
I compiled a list of 11 alternatives to the individual mandate. Most would require Congressional action, which could be a stretch. The alternatives come from a variety of sources. Ralph Lindeman of Bloomberg BNA ran through several concepts in an excellent March 23 piece for Bloomberg’s ongoing special report, “Health Care at the High Court.” I also drew on a Government Accountability Office report, Ryan Lizza’s March 27 piece on The New Yorker blog, and Ezra Klein’s Bloomberg View column from March 28.