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Experts: Supreme Court could reject 'individual mandate'

| Sunday, March 18, 2012

WASHINGTON -- When Barack Obama ran for president in 2008, he insisted the nation could fix its health care system without requiring everyone to carry insurance. As the Supreme Court prepares to weigh in on the health care law, Obama is facing the possibility that he may have to make good on his campaign claim.

Experts consider the requirement to hold insurance, known as the individual mandate, to be the most legally vulnerable part of the 2010 law.

The administration argues that the law's main goal of providing health coverage to 30 million additional Americans could not be achieved without the mandate because too many healthy people would refuse to obtain insurance, leaving primarily sick people in the insurance pools and driving up premium costs. Obama came around to this viewpoint after he was elected.

There are ways that Obama -- if he's re-elected -- might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say.

These fixes would create financial incentives for people to not delay enrolling in insurance.

One such approach would be similar to what happens in Medicare's Part B program, where people who wait too long to sign up for physician coverage must pay higher premiums.

Another tactic would exempt insurers from having to cover pre-existing conditions for several years for consumers who delayed obtaining coverage until illness struck.

But those changes would need congressional support, which is unlikely unless Democrats gain control of the House and a filibuster-proof majority in the Senate.

Absent federal legislation, experts say the Obama administration would need to forge a close alliance with insurance companies if it wants to prevent the overhaul from falling apart.

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