Proposition C: A Test of Freedom?
Posted By: Steven Lipstein 
Date Posted: July 28th, 2010 Category: Health Care
On August 3, Missouri voters will be asked to vote on whether or not federal health care reform should be upheld in the state. Missouri is the first state to hold such a vote, and while there are differences of opinion among attorneys as to what the vote will mean, the St. Louis Business Journal recently published the following commentary by Steven Lipstein, President and CEO of BJC HealthCare.
On August 3, Missouri voters will decide Proposition C, a statewide referendum on whether or not individual citizens of our state should be compelled by federal law to purchase private health insurance and participate in government-sponsored health insurance programs.
When Congress passed the Patient Protection and Affordable Care Act, our federal government established a new law that creates an “individual mandate”, a legal requirement for all citizens to purchase health insurance beginning in 2014.
Proponents of Proposition C believe that the new law violates a citizen’s individual right to decide whether or not they want to purchase health insurance. They argue that health insurance is different from other kinds of legally mandated insurance coverage such as car insurance. A citizen can decide not to own a car, and with that decision, is not required to buy insurance for the car.
Can a citizen decide not to buy health care services, and with that decision, not be required to buy health insurance? The answer is not as straightforward.
There is another federal law that is relevant. It is called EMTALA, the Emergency Medical Treatment and Active Labor Act. The law says that if any individual (whether or not covered by insurance benefits) comes to an emergency department, the hospital must provide a medical screening examination to determine if an emergency medical condition exists, and if it does, the hospital has an affirmative duty to provide treatment.
Who pays for emergency medical treatment provided to uninsured patients in compliance with EMTALA? You do. Hospitals pay the doctors, nurses, therapists, pharmacists, and technologists involved in the care of uninsured patients, and also pay for tests, drugs and other necessary care. The cost of these services provided to uninsured patients gets added to the bills of the patients who do have health insurance, making everybody’s health insurance premiums more expensive. Because the majority of us are covered by an employer provided insurance plan, this is a core business issue.
How does this affect your decision to vote for or against Proposition C?
If you believe that each citizen has a right to make an individual choice as to whether or not to have health insurance, you may be inclined to vote in favor of the proposition.
If, on the other hand, you believe it is unfair for those citizens who pay for health insurance to pay higher insurance premiums to cover the cost of emergency medical treatment for those who go without health insurance, you may want to dig deeper into this important societal issue.
If the law states that all citizens are entitled to receive emergency medical treatment, whether they are insured or not, is it not also reasonable that all citizens who benefit from that certainty of medical care, when needed, should also be required to share in its cost.
So, is an individual’s choice not to purchase health insurance an issue of “freedom”? What happens when that “freedom” causes an added financial burden of higher premiums for those who purchase health insurance? In the long run, the “freedom” that Proposition C would provide comes at an unsustainable cost to individuals and businesses.