We tend to think about ethics in terms of acute crises; in this view, ethical crises punctuate our mundane day-to-day life, presenting dilemmas that need to be solved with reference to moral principles, intuitions, or other guideposts. Rarely do we acknowledge that more everyday decisions have ethical or moral components, and that “ethics” apply to a broader range of decisions than we may care to admit. The decision to purchase health insurance is one such mundane decision that we at the Editorial Board argue should be cast in ethical terms.
Amidst the recent political and legal challenges to the Patient Protection and Affordable Care Act’s proposed individual insurance mandate, we argue that the purchase of health insurance as a healthy, young adult should be viewed as an ethical action. If you believe that being sick or healthy is largely a matter of good or bad luck that depends on genetics, socioeconomic status from birth, and other outside factors, being healthy is not a morally praiseworthy characteristic that should permit us – the young and healthy – to forgo insurance. Though diluting an insurance risk pool may be less glamorous than donating to charity, it is an important action that helps keep down premiums for the less healthy participants. Regardless of whether the individual insurance mandate stands or falls, we should keep in mind that as young, healthy adults, the purchase of health insurance should be aimed at more than our personal protection against expensive medical care.
The Affordable Care Act (ACA) extends the option to stay as a dependent on a family policy until the age of 26, in recognition of the fact that the transition from college to adult independence is often less smooth than parents may hope. At age 26, or before then for students who choose to leave their parent’s policy earlier, we’ll encounter the health insurance market: employer-sponsored health insurance or individual health insurance. If the ACA’s mandate stands, we’ll be required to purchase some form of health insurance or pay a monetary penalty of $695 per year (starting in 2016, scaling up from $95 in 2014) or 2.5 percent of income, whichever is higher.
As Ezra Klein points out in a Washington Post blog entry, for many young and healthy adults, it makes financial sense to pay the modest penalty and not purchase insurance. Since insurance companies under the ACA aren’t allowed to discriminate based on preexisting health conditions, young and healthy people can wait until they develop a medical condition that will be financially burdensome, and then purchase insurance instead of paying the penalty.
Furthermore, the law does not enforce payment of the penalty; no criminal action can be pursued against those who do not pay the fine. So why buy insurance if you’re among the “young invincibles,” if you’re a healthy, young adult who can afford insurance but chooses not to purchase it because you believe it is unnecessary?
The answer, though it may be unconvincing to some, lies in the distinction between the “rational choice” decision – choosing to forgo insurance and instead pay a modest penalty – and the ethical decision to help uphold the ACA’s vision of expanding health insurance coverage to millions. It goes without saying that many citizens do not fall in the “young” and “invincible” category – they have expensive chronic conditions that require insurance. They may be unemployed and lack affordable options in the individual insurance market, and joining an insurance risk pool as a young, healthy adult helps insurance companies avoid the “death spiral” they may face if their insurance pool is solely composed of sick, expensive-to-cover citizens.
Diluting the health insurance risk pool is not the first choice that comes to mind when we think about how to lead an ethical life, but we at the Editorial Board feel that regardless of whether or not the mandate is upheld, young adults have an ethical responsibility to aid in the accessibility of insurance by joining the insurance pool.