Ignore irresponsible opt-out advice on ACA mandate

  • Article by: EDITORIAL BOARD , Star Tribune
  • Updated: March 21, 2014 - 6:05 PM

Going without coverage puts your health and finances at risk.

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Photo: Courtney Perry • Special to the Star Tribune,

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With just eight days to go before a critical health insurance enrollment deadline, a Twin Cities-based “health freedom” group is offering some alarmingly risky advice to those who have yet to buy coverage.

Refuse to enroll’’ is the message on billboards in Minneapolis and four other U.S. cities put up by an organization headed by Twila Brase, a Minnesota activist known for her far-reaching views on medical privacy. Among other things, Brase’s group advocates for liberating Americans from “the wholesale tyranny that Medicare has become.” Medicare is the popular federal health program for those 65 and older.

Those who check out the billboard’s website will find several suggested ways to oppose “Obamacare Enrollment” and the Affordable Care Act’s coverage mandate — the requirement that beginning this year, Americans must have health insurance or pay a penalty if they abdicate this responsibility (with some exemptions). March 31 is the last day generally to sign up for coverage and avoid the penalty. In 2014, it’s $95 a person or 1 percent of income above the income tax filing threshold, whichever is greater.

Two key options offered up by Brase’s group: Paying the mandate penalty and going uninsured, or getting an exemption from the coverage mandate. The site conveniently neglects to say that both choices could leave you thousands of dollars in debt if you don’t have a health plan and need ongoing medical treatment. Another point irresponsibly left out: If you don’t pay, costs are passed along to taxpayers and in higher premiums for those with coverage.

These recommendations are so reckless that it’s unclear if Brase herself is willing to follow them — something that should give pause to anyone taking her seriously. Asked this week if Brase will personally will go without health insurance, a spokeswoman for the 55-year-old activist declined to answer, citing privacy concerns.

The prominent billboard near the junction of Interstate 94 and Hwy. 280 is the latest reminder of the long, often disingenuous debate over the “individual mandate” to buy health insurance. While the mandate was first embraced by conservatives as a tool to get people to take responsibility for their health care, its inclusion in the ACA’s approval in 2010 spurred a high-profile legal challenge led by conservatives. In 2012, the U.S. Supreme Court upheld the mandate by deeming the penalty a tax.

Since then, national debate has simmered over whether it’s more cost-effective for some, particularly young adults, to opt out of coverage and pay the penalty. That debate will likely escalate in the last days before March 31.

Opting out of coverage serves health reform opponents’ political aim of weakening the law but comes at high cost: putting an individual’s well-being and finances at risk. At first glance, it may appear that it’s cheaper to just pay the penalty than to buy a health plan. Yes, insurance is expensive, even with the newly available tax credits or public assistance available to those with low and middle incomes. (Brase’s website also recommends buying coverage outside MNsure but neglects to say that the new financial aid is available only to those who buy through the online marketplaces.)

But going without coverage is a gamble. No one, even young people, has magical protection from injuries or diseases. With emergency-room visits or short hospital stays easily costing thousands of dollars, a sports injury, appendectomy or asthma attack could saddle a young person with unnecessary debt and potentially damage their credit rating.

Looking at monthly premium costs alone also doesn’t tell the whole story. Under the ACA, many preventive services are covered at no cost, including contraception. For young women especially, coverage of this and critical screenings should be included cost-benefit calculations.

There’s also an intangible that comes with coverage. Kate Needleman, a 38-year-old mother of three from Minneapolis, until recently went without health insurance because it was unaffordable and family members were healthy. Then her 3-year-old, Irving, needed an $8,000 operation. The anxious family explored putting some of it on credit cards or getting assistance from hospitals. Fortunately, they found coverage they could afford through MNsure and got the care Irving needed. The peace of mind that comes with their new insurance, Needleman said, is “worth millions.”

  • the potential cost

    “You would still get the care you need. You just end up with tons and tons of debt. Since I already have student debt, I don’t need another $10,000 or $50,000 in hospital bills should something happen.”

    MITCH GRUSSING, a 28-year-old St. Paul piano instructor, on why he signed up for health insurance and why it’s important for other young people to get coverage.

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