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AHIP, BCBSA say some insurance reforms must be tossed if individual mandate found unconstitutional
WASHINGTON – An amicus brief filed with the United States Supreme Court by America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association contends that certain market reforms contained in the Patient Protection and Affordable Care Act are directly linked and must also be severed from the law if the justices find the individual insurance mandate unconstitutional.
In the brief, the two trade organizations focus solely on the issue of severability of the individual mandate and other market reforms directly linked to it. In so doing, the two groups take direct exception to the ruling of the 11th Circuit Court of Appeals in Atlanta that ruled the individual mandate is unconstitutional, but also kept whole other market reforms in the law.
"The central flaw in the 11th Circuit's holding that the minimum individual coverage provision is completely severable from the balance of ACA is that the court largely confined its analysis to the narrow question of whether ACA could structurally be operative or enacted as a law without the minimum individual coverage provision," the brief states.
Instead of such a narrow ruling, the brief contends the Supreme Court Justices should also consider if the law would continue to operate as intended if the individual mandate is severed from the law.
"It is this Court's duty, in executing a judgment of unconstitutionality (should one arise), to undertake a full severability analysis that determines which provisions are so dependent on the mandate that, to leave them in place, would violate congressional intent and would, in effect, judicially create a statute that Congress would not have enacted," the brief contends.
Specifically, without the individual mandate requiring people to purchase some form of health insurance, AHIP and BCBSA contend that other market reforms must also be severed. These include:
• A guarantee issue provision that requires health plans to offer healthcare coverage to any individual that applies for it;
• A prohibition on excluding pre-existing medical conditions from coverage or imposing a waiting period before coverage is effective;
• A prohibition on the establishment of coverage eligibility rules that are based on health status related factors; and
• The required use of an adjusted community rating system that prevents health plans from setting premium prices based on an individual applicant's medical history and that sharply limits variations in rates based on age, rating areas or tobacco usage.
A 2007 study by consulting firm Milliman Inc., which studied the market effects in states with guaranteed issue (GI) and community rating (CR) laws found that "In a GI and/or CR environment, the people who purchase insurance can have higher than average medical costs. When this happens, the insurance pool will have higher costs per member, and premiums will tend to increase…Increasing premium rates can, in turn, drive more low risk policyholders from the insurance pool, which leads to further rate increases. If this continues, the pool or market will essentially collapse or shrink to include only the higher risk population."
In the eight states studied by Milliman that have GI and CR laws, it found that the individual markets in the states deteriorated after the enactment of these reforms.
"Enacting guarantee issue and community rating has severe unintended consequences," an AHIP blog post noted, "unless they are paired with a strong commitment to achieve universal coverage through an effective and enforced personal coverage requirement."