Since its inception the Patient Protection and Affordable Care Act (PPACA) has been talked about and debated extensively, and now the Supreme Court is deciding on its constitutionality.  The primary focus during the hearings was on section 1501 of the law entitled Requirement to Maintain Minimum Essential Coverage, which is referred to as the “individual mandate.”  This section declares that every U.S. citizen must purchase a minimum amount of health coverage from the government or face a financial penalty.  Not surprisingly, the American public is somewhat divided on this.  Those that oppose the mandate argue that it presents a significant increase to the national debt and violates the Commerce Clause, which gives the federal government the right to regulate foreign and interstate commerce.  Opponents state that because the law declares the healthcare industry as interstate commerce, it will give the federal government control to regulate it how they see fit. They view this as the federal government superseding state governments, which is a violation of the 10^th amendment.  Advocates of the mandate proclaim that it will provide health care for those who can’t afford it, include those with preexisting conditions, and lower premiums.  By upholding the mandate, studies show the number of uninsured Americans will decrease by an estimated 24 million people.  While the general publics’ voice is often heard, mainstream media has largely overlooked physicians’ opinions on this matter.

So what do doctors think of the individual mandate?

Along with the belief that the mandate is unconstitutional, many doctors fear completely government-run health care.  In a recent survey conducted by The Deloitte Center for Health Solutions, 65% of physicians believe there will be a reduction in quality care for patients.  This reduction is a result of increased enrollment in Medicaid and Medicare and a higher demand for primary care services.  The study shows that 8 out of 10 doctors feel that because of this influx, wait times will be significantly increased which may lead to less one-on-one care for patients.  Adding to this point, the study also reveals 73% of physician’s believe ER’s could be overwhelmed due to the increase in patients.

The burden of excessive patient numbers isn’t the only thing that has doctors worried.  The study also showed doctors are concerned about their incomes.  Only 4% of the physicians surveyed felt that their income would increase as a result on the new health care law.  Almost half felt their income would decrease.

Not only is the new law impacting current physician’s but it’s also affecting the future of the profession.  The Deloitte study shows that nearly 7 out of 10 doctors think the best and brightest who may have considered becoming doctors will reconsider and look at other career options.  This potentially could have severe consequences on the industry.  In a study conducted by the Association of American Medical Colleges (AAMC), there will be a shortage of 124,000-159,000 physicians by 2025.  This decrease will come at a critical moment because as the number of insured rises due to the new law, more and more people will want to be treated.  This increase in patients and decrease in doctors will force doctors to spend less one-on-one time with patients, work more hours and make faster diagnoses in order to manage the steady increase in patients.

However some doctors are in favor of the individual mandate.  These doctors believe that by increasing the number of insured, premium payments will be spread among a larger population, which effectively lowers individual cost.  They also believe the mandate will stop “free riders,” people who don’t purchase health insurance because they don’t believe they need it.  Unfortunately when these people get sick their costs are transferred to the insured that receive increased premiums in order to pay it.

Similarly, supporters of the mandate say it can put an end to adverse selection.  This is when an individual opts to not purchase health insurance until they are sick and expect to pay high medical costs.  When this occurs, insurance companies are forced to increase premiums in order to cover their medical expenses.  As a result those that are healthy and under the same plan will drop their coverage because the cost is too high.  Out of fear of losing clients, most insurance companies will decline to cover people with preexisting conditions.  The mandate essentially puts an end to both free riders and adverse selection because everyone will have medical insurance despite their health.

Regardless of the debate, one thing is for certain – all eyes are on the Supreme Court and what is widely considered one of the most important decisions not only for President Obama’s legacy, but also for the nation as a whole.