Those involved in negotiations over the tax bill say the final version likely will include a repeal of the so-called “individual mandate.”
What that might mean for the ultimate passage of the measure is hard to say. Moderates hope to keep the Affordable Care Act from collapsing, but conservatives say they have no appetite for saving it.
The fight leaves congressional Democrats in an odd position.
Left to their own devices, many Democrats likely would abandon private health insurance and simply expand the government programs of Medicare and Medicaid, but the Obama administration in 2009 was looking for a bipartisan solution to the nation’s healthcare crisis.
Rather than push for the Medicare expansion Bernie Sanders talked so much about during last year’s presidential campaign, Democrats pulled out a plan that had been put forward by the conservative Heritage Foundation during the Clinton administration. The plan sought to provide universal coverage through a combination of government programs and private enterprise.
Republicans refused to get on board, though, and Democrats wound up approving what was effectively a compromise plan without a single Republican vote.
Ever since the law was enacted, Republicans have been campaigning to get rid of it, and the part they seem to hate the most is the individual mandate.
Democrats say the problem is that the system won’t work without the individual mandate. Repeal the mandate, they say, and the rest of the system collapses like a house of cards.
The thing both parties should remember is that most people like many of the provisions of the Affordable Care Act.
They like the fact that children can stay on their parents’ insurance policies until the age of 26. They like the fact that insurance companies can’t deny coverage for pre-existing conditions. They like the fact that there’s a limit to how much insurance companies can jack up their rates when customers grow old and sick.
What many Americans don’t like is being told that they have to buy insurance whether they need it or not and whether they can afford it or not.
What they’d like is to be able to wait. They’d like to be able buy insurance only after they get sick.
In a recent article for Forbes, physician Robert Pearl suggested that allowing someone to buy health insurance only when they need it is like allowing a homeowner to buy insurance only after the house is on fire.
He argued that repealing the individual mandate would harm the 15 percent of enrollees who aren’t currently receiving subsidies but who have ongoing medical problems.
“Many will have no choice but to stay on the exchanges, even when the young healthy participants leave and prices soar,” he wrote.
Pearl insists that the real solution is fundamental reform of a system that costs too much and wastes an estimated $750 billion a year.
“Regardless of whether the tax bill’s final version includes a repeal of the individual mandate, healthcare premiums will rise on the exchanges as out-of-pocket costs increase even more rapidly for everyone,” he wrote. “Both parties will blame each other, but the true culprit is the American healthcare system itself. And so far, the real problem has escaped congressional scrutiny.”
A recent survey by the Kaiser Family Foundation seems to support Pearl’s contention. It found that nearly eight in 10 Democrats would blame the Trump administration and Republicans if Obamacare were to collapse. A similar number of Republicans would blame the Democrats.
One thing Republicans might want to consider, though, is this: That same survey found that seven in 10 Americans support the expansion of Medicare, a plan Democrats could get behind in a heartbeat.