Cost Shifting From the Uninsured: Assessing the Evidence

By Glenn Hubbard, John F. Cogan, and Daniel P. Kessler

One of the most controversial provisions of the recently enacted Patient Protection and Affordable Care Act of 2010 is the mandate on individuals to obtain insurance.  A basic premise behind the mandate is that privately insured individuals bear a large financial burden from health care services provided to the uninsured.  According to the premise, doctors and hospitals, by charging insured individuals systematically higher prices for health care services, shift the costs of treating the uninsured onto the insured.  These higher charges are manifested in higher health insurance premiums.  The core of the law's view that the mandate is a necessary and proper exercise of Congress's power under the Commerce Clause of the U.S. Constitution is that it reduces or eliminates this cost shift. 

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