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For a short while, there was a very loud budget buzz about the Supreme Court case on the Patient Protection and Affordable Care Act (PPACA, sometimes known as “Obamacare,” which like “Bush Tax Cuts” is too close to a partisan epithet for this space).  The conventional wisdom was that the Court would strike down the so-called “individual mandate” (the requirement that individuals either purchase health insurance or pay a penalty) as unconstitutional.  It turns out that the Congressional Budget Office had estimated that striking the mandate would save the federal government money (see here).  Health insurance would be more expensive, and the government would not collect penalties from those who refused to purchase insurance, both of which would increase the deficit.  But on the other hand, fewer people would receive coverage under Medicaid, fewer would use federal subsidies to buy insurance, and there would be less tax-deductible spending on insurance.  The budget savings would be greater than the costs on net.  So naturally, Washington was atwitter over how to spend the windfall from the expected Supreme Court ruling; eliminating the automatic sequester of defense spending was the leading candidate.

But we have been spared that decision. Read More

Many view the 2010 health-reform law’s requirement to purchase insurance (or pay a penalty) as the central element in the current Supreme Court case.  After considering this “mandate” itself yesterday, the Court today will debate “severability:”  If the mandate itself is unconstitutional, could the rest of the law stand in its absence?  Or as a Washington Post headline put it today, “Could the health-care law work without the individual mandate?

Public-opinion polls seem to indicate that many people dislike the Affordable Care Act (ACA) as a whole, but like virtually all of its parts – except the mandate.  People do not want to be forced to buy something they do not want or need.  And because many people believe that they are immortal and will be forever young, one thing they do not want to buy is health insurance, which they will never need – or at least will not need until some year in the distant future, which they will know in advance and with certainty.

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