Federal judge shows why health insurance mandate has to stay

Conservatives are crowing over a federal judge's recent ruling that the requirement to purchase health insurance in the Affordable Care Act (a.k.a. Obamacare) is unconstitutional.

But Judge Roger Vinson's ruling actually showed that what Republicans have been claiming is false: it isn't possible to repeal the health insurance mandate and leave other more popular parts of the law intact.

Vinson came to the legally questionable conclusion that the mandate is unconstitutional. He then went further, saying that the entire Affordable Care Act should be struck down even though only this one part of it fails to pass constitutional muster. (In his opinion; about a dozen other judges have ruled otherwise.)

Why? Because the requirement that everyone in the United States have health insurance is central to the success of the other provisions in the law.

Unlike Judge Henry Hudson’s December ruling in a separate lawsuit filed by the state of Virginia — which struck down the individual mandate but left the rest of the law alone — Judge Roger Vinson ruled that the mandate is so central to the rest of the law that it can’t be overturned by itself.

“This Act has been analogized to a finely crafted watch, and that seems to fit. It has approximately 450 separate pieces, but one essential piece (the individual mandate) is defective and must be removed,” the judge wrote.

“There are simply too many moving parts in the Act and too many provisions dependent (directly and indirectly) on the individual mandate for me to try and dissect out the proper from the improper, and the able-to-stand-alone from the unable-to-stand-alone."

That's exactly what the Democrats and health policy experts (along with insurance companies) have been saying.

Republicans, for example, want to preserve the Affordable Care Act's prohibition on discriminating against people with pre-existing conditions.

However, this can only be done if there's a universal mandate to have health insurance, because otherwise many people will wait until they are seriously ill before they buy a policy — which, as I've noted before, would be akin to allowing a homeowner to purchase fire insurance after his house has burnt down.

So I'm actually encouraged by Vinson's ruling. It points to a fact that I'm confident is going to become more and more evident: for all of the Affordable Care Act's flaws, it is a well thought-out first attempt at fixing our seriously broken health care sytem.

If an activist judge, or repeal-minded Republicans, try to throw out central parts of the law they don't like, they're going to find that aspects they do like are going to fall by the wayside also.

Are insurance companies going to applaud if a serious attempt is made to repeal the mandate, while keeping the ban on denying coverage because of pre-existing conditions?

No. The screams of their lobbyists will be heard echoing through the halls of Congress. Bet on it.