Singing the praises of major U.S. insurance companies is not a common pastime on these pages, but recent events require at least a stanza and perhaps even a chorus. Such is the tuneful news that several have decided that no matter how the U.S. Supreme Court rules, they intend to retain certain provisions of President Barack Obama's health care reform law.
UnitedHealth Group, Inc. was the first to make that announcement and was later joined by Aetna and Humana. The move will allow policyholders to get certain kinds of preventive care without a co-payment, allow adult children up to age 26 to stay on parents' health plans, and avoid lifetime claims limits on individuals with chronic diseases, just as they would under the health care reform act.
UnitedHealth's leadership in this is particularly helpful because it is the nation's largest health insurer by market value. Still more companies may follow suit — if only to keep up with their competitors.
So why do this at all? UnitedHealth CEO Stephen J. Hemsley said it's simply good for his business. The changes are likely to improve their customers' health, promote better access to quality care and help control rising health care costs.
And that, after all, has always been the point of President Obama's Affordable Care Act — to reform the nation's failing health care system, improve treatment outcomes and get more people under private insurance plans. While the polls show the public is often skeptical of what is loosely referred to as "Obamacare," many of the actual provisions of the law are wildly popular.
Unfortunately, one of the most critical element of the health care reform law — assuring the coverage of people with pre-existing conditions — is not something UnitedHealth or other insurance companies can guarantee will survive the Supreme Court decision. It would simply be unaffordable to offer that benefit without the individual insurance mandate. Or, as UnitedHealth noted, "one company acting alone cannot take that step."
There are many other measures within the health care law that could die on the vine with the Supreme Court ruling, expected later this month — an expansion of Medicaid coverage and the creation of tax credits to help lower income families afford insurance coverage. It all likely hinges on an interpretation of the Commerce Clause, the provision within the U.S. Constitution that has provided the basis for much federal regulation of business from minimum wage and workplace safety laws to certain civil rights laws over the past seven decades.
If the Supreme Court throws out the mandate (or worse, the entire law), the consequences for tens of millions of Americans who either lack insurance or have pre-existing conditions would be dire. The chances of a dysfunctional Congress stepping in and crafting a reasonable fix to an adverse court ruling appear somewhere between zero and zero.
We have never claimed that the Obama health care law was perfect. It still leaves many Americans with insufficient coverage and it does too little to control costs. But at least it brought the U.S. closer to other developed nations of the world in guaranteeing that people, regardless of income, have access to decent and affordable health care.
That's why the law passed two years ago, and it's why Massachusetts adopted a similar model even earlier under Mitt Romney. Although he has disavowed Obamacare as a candidate for president, Mr. Romney pushed for the individual mandate when he served as governor and more recently has offered his years in the Bay State has evidence of his "strong leadership" skills.
Would Republicans prefer that the government actually take over health insurance with a Medicare or Medicaid-like "single payer" model? One presumes not, but without the individual mandate that may be the only possibility left for providing universal coverage.
At least insurers understand what is at stake and that consumers want the reforms (although not if they are called Obamacare). The decision by UnitedHealth and its competitors to do what they can to preserve some benefits to consumers is welcome. Certainly, there's nothing partisan in the choice.
But the decision is also a reminder of the limitations of what any one company (or several) can do without leadership from the federal government. We hope that the Supreme Court justices — nine men and women with access to generous government-financed health insurance — take that into consideration when they make their ruling.