It could not escape notice this week that the Virginia state Senate passed legislation that would make it illegal for any government body to require individuals to purchase health insurance.  The bill is expected to be passed by the state’s House of Delegates and then signed into law by Governor Bob McDonnell.

Virginia is one of the first states to take such action, but it almost certainly won’t be the last.  According to the American Legislative Exchange Council, legislative measures or proposed constitutional amendments have been filed in 35 states to challenge the idea of health insurance mandates.

This is a significant problem for the future of health reform.  One of the most popular components of the health reform bills that have passed both houses of Congress is the provision that removes pre-existing health conditions as a barrier to purchasing health coverage.  Even in our fractious society, there is virtual unanimity around the idea that having an illness shouldn’t leave individuals and families without health insurance and subject to financial ruin.

But we can’t enact that essential reform unless we also take steps to ensure that there is an individual responsibility to have health coverage.  Just as our property insurance system would collapse if individuals could wait until their house is on fire to buy a homeowners’ policy, so would our health insurance system be unsustainable if the healthiest among us could opt out until we became ill and needed an insurance plan to cover their expenses.

Understandably, lawmakers, in a challenging political environment, would love to pass laws making insurance companies issue policies to all comers, but they’re reluctant to impose health insurance mandates on their constituents. This, however, is a case where you genuinely can’t have the dessert without the vegetables.

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Mary R. Grealy is president of the Healthcare Leadership Council, a coalition of chief executives of the nation’s leading health care companies and organizations.  She is also the author of Prognosis:  A Healthcare Blog which explores the nexus at which healthcare policy meets healthcare practice.

If only it were an urban legend that senior citizens in the United States were cutting their physician-prescribed pills in half or ignoring their medications altogether in order to have enough money for food and utilities, but one doesn’t need academic studies to know that this kind of economically-forced non-adherence has too often been the case in our country.

After Congress passed the Medicare Modernization Act (MMA), creating the Part D prescription drug program, the Healthcare Leadership Council – an advocacy group comprised of chief executives of healthcare companies and organizations from all health sectors – literally took its show on the road. Having worked for passage of the MMA, we felt a responsibility to ensure that the new Part D program was implemented successfully and that seniors knew how to take advantage of the new benefit.

In community meetings across the country, I met with scores of elderly men and women who told me heart-wrenching stories of the hard choices they had to make between medications and other necessities, knowing they were putting their health at risk.

Has the Medicare Part D prescription drug program made a difference in drug adherence within this vulnerable population? The results are quite positive but they also show that further improvements remain necessary.

The impact of Part D on drug adherence among the elderly is unquestionable. A survey in April of this year by KRC Research (commissioned by Medicare Today, a coalition of local and national organizations we founded to provide reliable Part D information to seniors) found that three of every 10 Medicare beneficiaries reported that they are now taking medications that they had previously either skipped or rationed.

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