With the ongoing attempts to repeal the Affordable Care Act, one key argument against the ACA is that the mandate for all individuals to have health insurance coverage strips Americans of their right to make a personal decision. But is it only personal? Should individuals have the right to refuse coverage and go uninsured?
On paper in a zero-sum world, the answer to this question is easy. If you want to take the risk of not having health insurance, who is to stop you? Presumably individuals can weigh the cost of having coverage against the chance of needing medical attention and determine if they wish to forego coverage.
However, it’s not that simple. When others go without insurance, it not only comes at a cost to society, but also to the individuals who have elected to pay for insurance, as well as the businesses that provide it to employees.
Many argue that the lower-cost options under the ACA come with high deductibles that require patients to pay significant fees out of pocket. While it is true that there are high-deductible plans, it is important to note that a primary feature of the ACA was to ensure that preventative care is available to all Americans without being subject to any deductible.
In other words, any insured person can seek treatment for preventative or wellness benefits, such as annual physicals. These visits often uncover issues early on, when they are more easily and affordably treated. However, when an individual is uninsured, they are unlikely to seek treatment for seemingly minor issues. Often, these issues are exacerbated if they are not treated early.
The end result may be much more serious and costly emergency medical visits. In addition, with the rise of vector-borne diseases, such as Zika and others, when the uninsured do not seek treatment early it can lead to more rapid spread of the disease throughout society.