Over the last year as the myriad court cases about the federal health care law have made their way to the highest court in the land, California has spent that time moving ahead aggressively in implementing the Affordable Care Act (ACA). California was the first state to pass legislation to set up a health insurance exchange. The state also set up a new high risk pool so people with pre-existing conditions can get health insurance.
But what happens if the Supreme Court declares the individual mandate unconstitutional? Or overturns the entire law? What can still go forward in California?
The answer depends in part upon whom you ask. But for the most part California -- like all states -- will find it tough to move forward without the backing of the federal law.
Let's start with today's question -- is the individual mandate constitutional? The purpose of the individual mandate is to get everyone into the health insurance pool, to spread risk. If the Supreme Court overturns the mandate, but leaves the rest of the ACA intact, the big question is: "Will the health insurance exchange go forward?" The exchange is a marketplace the state is establishing for individuals and small companies to buy health insurance. This market currently sports higher health insurance premiums because these groups don't have the same purchasing power as large employers, for example. But without a mandate, there are numerous problems.
First, one of the ACA's most popular provisions is its requirement that insurance companies can no longer disqualify people with pre-existing conditions. Bill Kramer is Executive Director for National Health Policy at the Pacific Business Group on Health, a coalition of large employers that is working to improve health care quality and reduce cost. He says if the mandate was overturned, "a fair number of people would choose not to get coverage, and you'd end up with the sickest people continuing to get coverage. It would be a high cost risk pool in individual markets."