Health Care

Why Congress (Probably) Won’t Scrap the Individual Mandate

By Kate Pickert | @katepickert | February 8, 2011 | +

Ezra Klein of the Washington Post has said a version of this already today, but it’s worth repeating. There is only a very, very slim chance that the individual mandate will be repealed by Congress, despite Politico’s contention that the policy might be on the ropes thanks to four Democratic senators.

As Ezra points out – and as I have in the past – there are viable alternatives to the individual mandate, the goal of which is to prevent Americans from purchasing health insurance only when they get sick. The alternatives to forcing people to buy insurance are so viable and the mandate so controversial, I’ll bet some Administration officials and congressional Democrats are kicking themselves for not considering them more seriously. But consider them seriously and publicly they did not. The health insurance industry, which is guaranteed a huge new base of consumers by the individual mandate, is part of the reason.

Yet, for the reasons it might seem possible, it’s hard for me to imagine the scenario Politico does, in which a few moderate Democrats lead a successful charge to reform or replace the individual mandate. The reason: politics. Sens. Joe Manchin, Claire McCaskill, Jon Tester and Ben Nelson – all up for re-election in 2012 and identified by Politico as threatening the future of the individual mandate – aren’t going to support repealing it without a replacement that has real teeth. They might be willing to entertain the idea of a strict open enrollment period or even a new tax on every American that’s then waived for those with health insurance. (These are two of the most oft mentioned alternatives that would easily pass constitutional muster.) But these four senators can’t pass such a change alone. They would need Democratic or Republican support and they’re probably not going to get it.

The bulk of Democrats who crafted and passed the individual mandate aren’t anxious to scrap the policy and thereby admit they made a huge political, policy and possibly constitutional error. And so long as Republicans are leading the legal challenge to the individual mandate in federal court – and are wracking up high-profile wins along the way – they’re not likely to cancel out that effort by getting rid of the mandate in the meantime. Plus, Republicans in both houses of Congress just voted to repeal the entire Affordable Care Act, not the kind of move that signals a willingness to surgically improve various aspects of the sweeping new law.

(That said, I think it’s very possible that factions of Republicans and Democrats could join together to change some other less important provisions of the law in the next several years.)

Related Topics: affordable care act, Ben Nelson, claire mcCaskill, health care reform, health reform, individual mandate, joe manchin, jon tester, politico, Health Care

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  • afguy

    Goldmine for the insurance companies?
    .
    Is that the reason you were thinking of?

  • http://grapemusing.blogspot.com/ grape_crush

    …and are wracking up high-profile wins along the way…

    1) ‘Racking up‘

    2) What makes the two judgments upholding the ACA’s constitutionality less ‘high-profile’ than the judgments against?

  • Ivy_B

    The limited amount of media coverage?

  • afguy

    When others trot out the poll number that says 60% or so of the American people want to repeal the bill, THIS is the part they are talking about.
    .
    But, then, they roll the numbers onto a “blanket” disapproval for the entire bill (which it ISN’T).
    .
    We were told (repeatedly) that the “public option” didn’t have the votes to pass before. Fine. Throw it out there for consideration and see.
    .
    That whole process reminded me of the legal axiom of “never ask a question you don’t already know the answer to”.
    .
    Were they afraid that they DIDN’T really know the answer to it’s popularity… so they never posed the question officially?
    .
    It WOULD have been quite embarrassing to put it to a vote and lose, after telling us over and over how unpopular it was.
    .
    Refresh my memory – was there another substantial proposal in the HC debate that was rejected out of hand, without a vote like this was?
    .
    Not my ball of wax, anyway. I’ll be long gone before any of this gets implemented, but I woudl like to see the situation better for the kids.

  • apr2563

    Posted this before, but why not share it again for the Swamp reporters to digest.
    .
    http://www.washingtonmonthly.com/archives/individual/2011_02/027790.php
    .
    Note the pages the stories were on in print media and the amount of stories. This of course drove the echo chamber stories on television.
    .
    Washington Post
    * Steeh ruling (pro-reform): A2, 607 words
    * Moon ruling (pro-reform): B5, 507 words
    * Hudson ruling (anti-reform): A1, 1624 words
    * Vinson ruling (anti-reform): A1, 1176 words

    New York Times
    * Steeh ruling (pro-reform): A15, 416 words
    * Moon ruling (pro-reform): A24, 335 words
    * Hudson ruling (anti-reform): A1, 1320 words
    * Vinson ruling (anti-reform): A1, 1192 words

    Associated Press
    * Steeh ruling (pro-reform): one story, 474 words
    * Moon ruling (pro-reform): one story, 375 words
    * Hudson ruling (anti-reform): one story, 915 words
    * Vinson ruling (anti-reform): one story, 1164 words

    Politico
    * Steeh ruling (pro-reform): one story, 830 words
    * Moon ruling (pro-reform): one story, 535 words
    * Hudson ruling (anti-reform): three stories, 2734 words
    * Vinson ruling (anti-reform): four stories, 3437 words

  • nflfoghorn

    Score: two judges for HCR, two against, and 12 who don’t even think neocon AGs’ arguments are worth the trouble.
    .
    “Racking up”???

  • troubador222

    I was wondering that too. Even NPR has paid quit a bit off attention to the two cases against and not much at all to the ones where it passed.

    Though a lot of their coverage has been about the perception of judicial over reach on the last one, in the negation of the entire law.

  • Matt

    Missing from the debate over the future of health care reform as passed by Congress and signed by President Obama is that the health care industry and insurance companies do not want tit to be “repealed” or be changed in any significant way. If they don’t want it to disappear, it won;t. Health care reform and the mandate literally drops millions of new paying customers at their feet without a hint of effort on their part.

    Say they start insuring some of these people before the mandate kicks in, then Republicans repeal the law and the folks that bought a policy thinking they had to suddenly pull out. That costs insurers billions, and they will not let that happen.
    http://www.sunstateactivist.org

  • http://shortplaysaboutrealpeople.wordpress.com Michael Maiello

    Just repeal the mandate. If “free rider problem” is real (and it isn’t) then a bunch of insurance companies will go under and the government will have to step in with a public plan to replace them. If, as I suspect, it’s not real, then it won’t matter.

  • jsfox

    I would really like to know what convinces you the free ride issue is not an issue.

  • nflfoghorn

    To force us to have insurance, or not: That is the question.
    .
    If you can’t (in the high unlikelihood that that part of HCR will be shot down), then a tax can easily be levied to do it.
    .
    The idea to make everyone carry ins is in part because, well, maybe you’ll think about going to the doctor and get healthier.
    .
    Not to mention sharing the cost of doing that with everyone else, versus taking taking a trip to the emergency room and expecting me via my taxes pay for the health care you can’t afford.

  • freeinpa

    “Not to mention sharing the cost of doing that with everyone else, versus taking taking a trip to the emergency room and expecting me via my taxes pay for the health care you can’t afford”
    .
    And exactly how this different from having to pay for that and more through insurance premiums?

  • nflfoghorn

    Going to the doc before there’s a serious problem that requires expensive, probably sub-standard medical care lowers premiums, gives us all a better shot at living longer, and…
    .
    …wait for it…
    .
    SAVES US ALL MONEY!!!!
    .
    This has been another episode of Simple Answers to Neocon Questions.

  • earljr1

    The democrats are in a quandary and they know it. In their haste to proclaim “victory” at any cost, they have saddled the American public with a mish mash of legislation that leaves millions uninsured and drives up the premiums for everyone else.
    Couple this with a deeply resentful health care community, alienated seniors and a public growing more angry as Obamacare unfolds, then I would say a major crisis is impending.
    Virtually every democratic politician distanced themselves from this legislation during the mid terms and the outcome of those elections reinforced the public’s disenchantment with Obamacare.
    If not repealed or found unconstitutional by the supreme court, the bill will be significantly altered from its present form.
    That, ladies and gentlemen, would be a GOOD thing.A very, very good thing!

  • shepherdwong

    “To force us to have insurance, or not: That is the question.”
    .
    Not really. “Individual mandate” is another one of those rhetorical bear traps that Democrats keep setting for themselves, before stepping in it. The individual mandate mandates that you either buy health insurance, or not (some “mandate”). The “or not” works a lot like Medicare: you pay into the system that you are going to need use one day (if you don’t simply drop dead beforehand) but you are not forced to buy insurance.

  • libssd

    If you can’t (in the high unlikelihood that that part of HCR will be shot down), then a tax can easily be levied to do it.

    In the current congressional environment, the prospect that “a tax can easily be levied to do it” strikes me as having about the same probability as a snowball in hell.
    -
    Despite its (many) shortcomings (most notably lack of a single-payer provision), overall, I view the present healthcare bill as a positive development, but I’m not blind to the facts on the ground, in the form of D/R representation in the House and Senate.

  • fumbles1

    “The democrats are in a quandary and they know it. In their haste to proclaim “victory” at any cost, they have saddled the American public with a mish mash of legislation that leaves millions uninsured and drives up the premiums for everyone else.”

    A couple of the goals of the law was to reduce the number of uninsured people and control the cost of premiums. I don’t know if it will succeed or not, but I see no reason not to wait and see how well it works. If there are problems, they can be fixed then.

    The worst thing we could do is argue about it until the entire system collapses. This is already passed. Lets see how it works and go from there.

    “Couple this with a deeply resentful health care community, alienated seniors and a public growing more angry as Obamacare unfolds, then I would say a major crisis is impending.”

    This, i think, depends on your perspective (or, more likely which news source you watch). I suspect that people are just apprehensive, just because nobody really knows how it will effect them. People will calm down after it’s fully implemented.

    “If not repealed or found unconstitutional by the supreme court, the bill will be significantly altered from its present form.
    That, ladies and gentlemen, would be a GOOD thing.A very, very good thing!”

    I agree! I don’t see how it’s possible to create a new system this complicated and get it perfect the first time. There are bound to be flaws and inefficiencies (some significant). But it is impossible to know what those flaws are until it gets fully implemented.

  • fumbles1

    “And exactly how this different from having to pay for that and more through insurance premiums?”

    I thought this was an interesting read: http://en.wikipedia.org/wiki/Health_care_in_the_United_States

    Some quotes regarding insured vs uninsured care:

    “A 2003 study in Health Affairs estimated that uninsured people in the U.S. received approximately $35 billion in uncompensated care in 2001.” (mostly provided through taxes or borrowing).

    “Uninsured Americans are less likely to have regular health care and use preventive services. They are more likely to delay seeking care, resulting in more medical crises, which are more expensive than ongoing treatment for such conditions as diabetes and high blood pressure.”

    “In 2008 researchers with the American Cancer Society found that individuals who lacked private insurance (including those covered by Medicaid) were more likely to be diagnosed with late-stage cancer than those who had such insurance.”

    “They concluded that almost 100,000 people died in the United States each year because of lack of needed care.”

    “In fact, more than half of all emergency care in the U.S. now goes uncompensated. According to some analyses, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding.”

  • apr2563

    The brilliant Senator from Nebraska, Ben Nelson, thinks we can substitute the individual mandate by having people that chose not to buy insurance simply sign a statement that if they become ill, they will pay for their own health care needs. Guy is so smart. If they don’t pay, I guess they get sent to a northern Nebraska gulag.

  • shepherdwong

    Ben Nelson is the poster-boy for the problem of of having to have two senators for every wind-swept wilderness in flyover country. Not only do tiny mid-western populations receive representation far beyond their respective numbers but we also get some of the biggest fatheads and dumbest sh!t-kickers available in the country to do the representin’.

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