Alternatives To Mandating Insurance? Maybe The requirement for most individuals to either have insurance or pay a penalty is frequently described as the "linchpin" of the sweeping health care law. But there may be some viable alternatives.
NPR logo

Alternatives To Mandating Insurance? Maybe

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Alternatives To Mandating Insurance? Maybe

Alternatives To Mandating Insurance? Maybe

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


The president also faces challenges to the Health Care Law. The big issue is the requirement that most people must buy health insurance or pay a penalty. Opponents say that part of the law is constitutional.

And as that works its way through courts, NPR's Julie Rovner went to see if there are any viable alternatives. went to see if there are any viable alternatives.

JULIE ROVNER: So far, two federal judges have called the requirement to have health insurance unconstitutional. The lawsuits have a long way to go, but a lot of people are already saying I told you so. And not just Republicans who opposed the entire measure, but Liberals who support the law's goals.

People like Jamie Court, president of the California-based advocacy group, Consumer Watchdog. He says people don't like to be told want to do.

JAMIE COURT: Seventy percent of the public is consistently against it, and even when you explain that it will save everybody money, there's not a majority of the public for it.

ROVNER: So if the requirement is so controversial, why did lawmakers include it? They say without it you can't require insurance companies to stop discriminating against people with pre-existing health conditions. You need healthy people to buy insurance too, to make the system work.

Paul Starr is a health care expert who teaches at Princeton

PAUL STARR: If you have a ban on preexisting condition exclusions, then it's actually rational for somebody for only to start paying when they're sick. Well, you just can't have that.

ROVNER: But is requirement for people to have health insurance the only way to make sure that happens? Starr is among those who say not necessarily.

STARR: What you can do, instead of a mandate, is to say to people that if you want to opt out, okay. Sign a form and acknowledge that you won't be eligible to opt back in and you're out for five years.

ROVNER: Five years during which you won't be eligible for any of the law's new benefits. That means no government subsidies and no buying from the new health exchanges. And you can still be discriminated against if you have a preexisting health condition. Sound familiar?

STARR: You're basically opting into the world we have now.

ROVNER: Starr says that should encourage most people to buy coverage. But some analysts worry that still might not get enough healthy people to sign up as a actual mandate would.

Len Nichols, a health economist who teaches at Virginia's George Mason University, says if there is no mandate, Congress might have to find another way to make the consequences of not having insurance even more dramatic. For example, he says, perhaps if people don't buy insurance when it is first available...

LEN NICHOLS: Then if you ever try to buy insurance again, you'll have to pay three times the market price, and we will put a gold sticker on your forehead and say to all hospitals, you do not have to treat this person; this person has forfeited their right to uncompensated care.

ROVNER: Now, Nichols is only half serious about that gold star. He's quick to point out that doctors and hospitals are bound by professional standards not to turn away patients in need of emergency care. So he says Congress may want to consider another option: Make the states do the hard work. Withhold all the federal funding in the health law unless states require people to have health insurance. That's how Congress got states to lower speed limits in the 1970s.

NICHOLS: It would have the virtue, probably, of avoiding the constitutional debate. It would have the downside of enabling states that were not inclined to expand coverage for their population, they would then have an out, and they would withdraw from the reform.

ROVNER: Consumer advocate, Jamie Court, says he things the problem is simply that insurance is too expensive. His proposal? Give states more power to reject large health insurance premium hikes.

COURT: The easiest way to get more people into the health insurance pool is to make health insurance more affordable.

ROVNER: But the insurance industry says lowering rates doesn't do anything to lower underlying health care costs. Still, a spokesman for the industry's trade group who declined to go on tape, said the industry would find any of the other ideas that get more healthy people into the insurance market a welcome thing.

Julie Rovner, NPR News, Washington

Copyright © 2011 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.