Both the policy justification, and part of the Constitutional justification, for including the individual mandate in Obamacare is that the individual mandate will eliminate “free-riding,” in which the uninsured take advantage of free emergency-room care at taxpayer expense. This, from Judge Vinson’s ruling:
The defendants contend that there are three unique elements of the health care market which, when viewed cumulatively and in combination, belie the claim that the uninsured are inactive. First, as living and breathing human beings who are always susceptible to sudden and unpredictable illness and injury, no one can “opt out” of the health care market. Second, if and when health services are sought, hospitals are required by law to provide care, regardless of inability to pay. And third, if the costs incurred cannot be paid (which they frequently cannot, given the high cost of medical care), they are passed along (cost-shifted) to third parties, which has economic implications for everyone. Congress found that the uninsured received approximately $43 billion in “uncompensated care” in 2008 alone. These three things, according to the defendants and various health care industry experts and scholars on whom they rely, are “replicated in no other market” and defeat the argument that uninsured individuals are inactive.
The contention that the individual mandate is necessary, because it solves the “free-rider” problem, is worthy of further examination: because it suffers from numerous conceptual and factual flaws.