To those who haven't followed the health care debate closely until now, you might be surprised by one of California's leading proponents of universal coverage. It's Bruce Bodaken, CEO of Blue Shield of California, one of California's largest health insurance companies. He first proposed a system of universal coverage for Californians ten years ago.
"At that time, there was 20 percent of Californians without coverage," he said in an interview with KQED. "We looked at that in one of the richest societies in the world and said, 'Simply unacceptable for people not to have at least basic health care.' So we proposed that all people in California have at least basic coverage. Those that can't afford it would be subsidized and all groups and individuals would be mandated to be covered."
It sounds a lot like the Affordable Care Act (ACA) being considered by the Supreme Court this week. Tomorrow, the Court will hear oral arguments about the constitutionality of the individual mandate -- the requirement that all Americans have health insurance. Those opposed say that Congress has exceeded its authority in requiring Americans to purchase a product.
Bodaken doesn't see it that way. "I'm no lawyer and the Court will decide whatever they decide," he says. "But I do know this -- we mandate many things in this society. ... I have to send my children to school, at least to a certain age. If you want to drive a car, you have to have auto insurance. I don't think this is all that different."
Tuesday, lawyers arguing in favor of the individual mandate are expected to make what -- at first glance -- looks like an odd request. They will ask the Court that if Justices decide to strike down the individual mandate, that they also strike down a very popular provision of the ACA, the "guaranteed issue" provision. You might know it as the requirement that insurers accept everyone, regardless of pre-existing medical conditions. Bodaken understands why the Obama Administration would ask the Court to strike down guaranteed issue if it declares the individual mandate unconstitutional.
"If we don't have everyone in, those that need care and those that don't need care," Bodaken says. "There are not enough premium dollars going into the pool to make it affordable for everyone." Bodaken went on to give a hypothetical example: he's a runner and asked what could happen if he needed a knee replacement. If there were no mandate to be insured, he could remain uninsured until the last minute.
"Then I would go in, have coverage for a couple months, have surgery that might cost $30-50,000, and then drop coverage. Obviously, that doesn't work."
Blue Shield of California, like other health insurers, has come under fire for rising premiums. Bodaken could not precisely predict prices, because the exact benefits under the ACA have not yet been set. But he does anticipate more affordable coverage if everyone in California has health insurance. "The increases over the last few years to a great extent is that the market has gotten smaller with the recession. ... Only the people that are the sickest stay in and everyone else drops off."
In some ways, is it such a surprise that a health insurance executive would support a government mandate that would bring his company more customers? "Our concern was not whether or not we would get additional enrollees," Bodaken countered. "We will get our fair share and that's great. What's really important -- whether Blue Shield gets one more enrollee or none -- is that people in California, indeed in the United States, have access to good care, at least in terms of the basics of health care."