Obamacare, Citizenship, and Neighbor Care

As debate over the upheld Affordable Care Act (ACA, or Obamacare) remains intense, I’d like to enter the fray by focusing on the individual mandate and the terms associated with the cost levied at those who opt not to purchase health insurance.

Two key words—tax and penalty—are primarily used to describe this cost, and the most intense debate I’ve heard has been over which of the two the levied cost is. There’s actually a third term for the cost, which is unfortunately and all-too-often neglected.

As Supreme Court Chief Justice John Roberts says in the case’s majority opinion, the ACA initially designated the levied cost a “shared responsibility payment.” The payment was classified as a penalty since the IRS, which is responsible for collecting the payments, had to find an existing category for it. To simplify Justice Roberts’ argument, the fact that the IRS collects the penalty through annual income taxes allows for the penalty to be considered a tax.

Those who criticize the individual mandate as an interference with freedom and rights almost always use the terms “tax” and “penalty.” People against the mandate raise this basic question: “Why should I have to pay for other people’s healthcare?” To return to the ACA’s core term for the cost, we could rephrase the question to this: “Why should I have to be responsible for other people’s healthcare?” They feel their freedom has been limited by penalizing them for making a personal choice and for not wanting to pay for other people’s healthcare.

Things look differently when we reverse this question about being responsible for others. When reversed, the question becomes: “Why should we, the insured, have to pay for your healthcare once you finally need it but don’t have insurance?” If one prefers the question “Am I my brother’s keeper?” (Genesis 4.9), we should also reverse it to ask: “Is your brother your keeper?”

These questions and counter-questions point out that people will almost certainly have to absorb the cost of other people’s medical costs either way—it’s essentially a issue of who pays for whom.

If we think about what the long-term consequences would be if the individual mandate hadn’t been upheld, we have to admit it is nearly impossible to be solely responsible for your health. Those who would forego healthcare insurance would end up either causing those who have healthcare insurance to pay or severely draining their financial resources (and quite possibly their family’s resources, too).

Hospitals are obligated and under oath to treat anyone who comes needing medical assistance, even if they can’t afford help. So someone else has to pay for the treatment. As Justice Roberts explained, hospitals pass on costs to insurers through higher rates. Insurers then forward costs by raising insurance premiums for the already-insured.

It’s simply unfair for someone to forego insurance for years, using her or his money however he or she sees fit—and eventually end up needing medical care with nowhere near enough funds to pay for vital care.

Some might argue that those foregoing healthcare insurance could instead save enough money to pay for their medical care once they need it. But this seems unrealistic, given that a large percentage of Americans live in debt, and very few Americans save money as they should. The idea that they will not just save money but also set aside a specific amount of saved money for a health emergency is improbable, especially amidst the current economic downturn (which isn’t expected to improve in the near future).

Even if those foregoing medical coverage do save, there is little guarantee that they will have saved enough. They might easily be able to cover the cost of what GOP presidential nominee Mitt Romney has called “a 1,000 repair,” but covering the cost of a long-term illness like cancer would be far more difficult, if not impossible. Most of those who opted to save on their own would see decades of savings quickly dwindle in a matter of months or a couple years.

I appreciate and commend those who reject the individual mandate for their desire to preserve freedom. We should be ever-watchful against threats to freedom. But it’s important to remember that freedom and responsibility are intricately connected. But in the case of the individual mandate, we may actually be experiencing a step toward responsibility rather than an erosion of freedom. The individual mandate drives people who might take serious risks on their health to reconsider the importance of spreading risk and costs through healthcare insurance.

As Christians wrestle with finding where freedom and responsibility intersect at the individual mandate, four things are worth thinking about.

Christ’s instruction to give “to Caesar the things that are Caesar’s, and to God the things that are God’s” (Mark 12.17) should be kept in mind. Chief Justice Roberts’ logic for the shared responsibility payment qualifying as a tax and thus being constitutional is indeed a stretch, but nonetheless the chief judicial authority of America has decreed the individual mandate legal. Christians can vote for Mitt Romney, who has promised to begin repealing the ACA on the first day of his presidency (even though he has said “I like mandates” in the past). But they cannot evade paying their taxes even if they disapprove of the individual mandate.

Christians should also rethink how they approach debt, having realized you might cause financial hardship on others if the individual mandate had been struck down and you were entitled to forego healthcare insurance. It’s well to keep in mind the instruction given by the wife of one of the prophet Elisha’s sons: “Go, sell the oil and pay your debt, and you and your sons can live on the rest.” The individual mandate pushes you to protect yourself by purchasing insurance rather than gambling on your well-being.

We must also keep in mind that governments have the task of protecting their citizens. When the Israelites demanded a king (I Samuel 10.17-27), the central concern was finding someone who could deliver Israel from the Philistines (I Samuel 9.16-17). But protection isn’t confined to defending a population from external threats (i.e. enemies). There’s also domestic protection, providing for people’s material well-being (what’s known as biopolitics in political theory). The individual mandate may even end up protecting you, even if you dislike it. If you choose not to purchase health insurance and pay the shared responsibility payment, the mandate may end up allowing you to get insurance once you need it. Without the mandate, many insurers could turn you away due to your illness, which they would consider a preexisting medical condition.

Finally, let us not forget Christ’s warning that “whoever says to his brother, ‘You good-for-nothing,’ shall be guilty before the supreme court…” (Matthew 5.22). If you think of the disadvantaged poorly because they are unable to afford medical care and resent having to pay for them, Christ’s warning gives you reason to examine if you need to repent for hating your fellow Americans. The Supreme Court’s ruling on the legality of the individual mandate is a chance to reconsider your fellow Americans’ worth as you abide by this new legislation, even if you dislike it (see Romans 13). Perhaps the passing of this legislation may, strangely enough, even lead to your heart being changed and becoming more loving toward others.

Further CaPC coverage of the Affordable Care Act/Obamacare:

– Ben Bartlett: “Obamacare, the Supreme Court, and the Darkness of Hearts” (April 2012) and “Watching Politics from the Pew: The Cost of Healthcare and Wisdom” (November 2011)

– Podcast: ObamaCares? (March 2010)

Illustration courtesy of Seth T. Hahne. Check out his graphic novel and comic review site, Good Ok Bad.