Insurance Mandate was Never Wise | Beaufort County Now | Should all Americans be required to purchase health insurance? This was a major bone of contention among conservative reformers during the health care debates of the 1990s | Insurance Mandate,Health insurance,Hillary Clinton,Barack Obama,healthcare

Coronavirus Disease 2019 (COVID-19)

Insurance Mandate was Never Wise

    Publisher's note: This article appeared on John Hood's daily column in the Carolina Journal, which, because of Author / Publisher Hood, is linked to the John Locke Foundation.

    Should all Americans be required to purchase health insurance?

    This was a major bone of contention among conservative reformers during the health care debates of the 1990s. It was an issue during the 2008 contest for the Democratic presidential nomination, with Hillary Clinton saying yes and Barack Obama saying no (President Obama ended up flipping to the Clinton position).

    After its inclusion in the Affordable Care Act, the individual mandate became the primary issue in legal challenges that ended up before the U.S. Supreme Court. Remember that the majority opinion upholding it, by Chief Justice John Roberts, didn't actually conclude it was constitutional for Congress to compel private purchases. Rather, Roberts retroactively redefined Obamacare's policy as simply a tax on the uninsured.

    As a matter of health policy, the mandate had a seemingly inescapable logic. If government were to force insurers to cover everyone, but not require everyone to purchase insurance, then people would wait to sign up until they are sick. There wouldn't be enough revenue to finance payouts. Insurance pools would contract, then collapse.

    In practice, however, the ACA's individual mandate didn't really work this way. The heavily regulated plans on the insurance exchanges were also heavily subsidized. If insurers lost money because their subscribers were older and sicker than expected, they raised their prices. The extra cost was borne not primarily by exchange customers but by taxpayers, so enrollment didn't plummet.

    At the same time, the mandate proved insufficiently stringent and inadequately enforced to pull younger, healthier customers into the exchange pools. Particularly if they weren't eligible for massive subsidy, Americans compared the soaring cost of ACA plans with the penalty - oh, sorry Justice Roberts, the "tax" - they would incur from being uninsured, and chose the latter, cheaper alternative.

    I'm reminding you of this history because, at last, the individual mandate is going away. It was eliminated by the federal tax-reform bill passed in December. And the sky is not about to fall.

    As American Enterprise Institute scholars Joseph Antos and James Capretta pointed out in a recent Health Affairs article, the Congressional Budget Office has downgraded its estimate of the number of Americans who will choose not to buy insurance in the absence of the mandate. CBO's earlier predictions were distorted beyond all recognition by progressives - choosing not to pay inflated prices for a product you don't want isn't the same thing as "losing health coverage" - but now it seems those forecasts were exaggerated, as well.

    What will happen next? On the Left, there is still a widespread belief in a single-payer, government-run system. Here in North Carolina, Rep. Verla Insko (D-Orange) even filed a bill to make that happen in our state next year. But Insko pulled her bill from consideration last week when legislative staff estimated its total cost at $72 billion, including $30 billion in federal funds and a whopping $42 billion in state dollars. By comparison, North Carolina's entire General Fund budget is about $24 billion.

    On the Right, there are some unrealistic expectations, too. The ACA exchanges aren't going to wither away. And as long as Medicaid expansion exists as an option, the powerful interests who actually receive Medicaid funds - hospitals, doctors, and pharmaceutical companies, not the low-income enrollees - will lobby strenuously until they get it.

    Conservatives should hasten and formalize the transition of the exchanges into high-risk pools, the policy Washington and the states should have pursued in the first place. In other words, the cost of treating people with expensive preexisting conditions will be spread over a broader pool of taxpayers, rather than overcharging others in the individual insurance market.

    Federal policymakers should reform Medicaid to limit its scope and cost, while state policymakers should deregulate both insurance benefits and medical providers to reduce the actual costs of policies and medical services, rather than trying to shift and hide those costs.

    The individual mandate was an affront to American principles of freedom. It's finally gone. Now, let's make sensible decisions about what comes next.


HbAD0

Latest Op-Ed & Politics

The University of Notre Dame joined a growing list of universities that are requiring students to be vaccinated against COVID-19 in order to return to campus for classes in the fall.
Most people are generally aware that the Chinese are attempting to take over the United States in a variety of different ways, most of which are economic and military.
We will offer this allotment of three with more to come; some old, most new, but all quite informative, and, moreover, necessary to understanding that in North Carolina, there is a wiser path to govern ourselves and our People.
Judicial Watch today released a transcript of the March 24 oral argument before the U.S. Court of Appeals for the District of Columbia Circuit challenging a lower court ruling upholding the secrecy of controversial secretly-issued congressional subpoenas
At this time, by their every action, word and eventual deed of the Leftist Socialist non patriots, it is fully clear that this 2020 General Election was a coordinated effort to defraud the non Socialist electorate by colluding with multiple interested parties to create The Big Cheat of 2020.

HbAD1

Gov. Roy Cooper on Friday, April 9, signed two bills into law designed to help students who lost more than a year of in-person learning because of the pandemic and subsequent lockdowns.
David Drucker of the Washington Examiner highlights a political fault line exposed by Georgiaís new voting law.
Graham Piro of the Washington Free Beacon reports on labor unionsí response to the presidentís bloated infrastructure package.

HbAD2

There is a known revolutionary in the NCAE. Does this frighten you? It should, and here's why!

HbAD3

 
Back to Top