A Mandate By Any Other Name Is Still a Mandate

Last night the Republicans released their Obamacare repeal/replacement plan. They’re calling it the “American Health Care Act” or AHCA (I’m sure there’s no intention to confuse people with the ACA, is there?) If you’d like to read a summary of what it does/doesn’t do, I’d recommend checking out what has been written by Sarah Kliff, Tierney Sneed, Kevin Drum and/or Michael Hiltzik.

After checking in with all those expert wonks, I think that Ezra Klein nailed the overarching problem with this:

It is difficult to say what question, or set of questions, would lead to this bill as an answer. Were voters clamoring for a bill that cut taxes on the rich, raised premiums on the old, and cut subsidies for the poor? Will Americans be happy when 15 million people lose their health insurance and many of those remaining face higher deductibles?…

This bill has a lot of problems, and more will come clear as experts study its language, the Congressional Budget Office release its estimates, and industry players make themselves heard. But the biggest problem this bill has is that it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people?

Klein’s questions are important because no matter how Americans feel overall about Obamacare, we’ve seen in poll after poll that big majorities (including Republicans) approve of its individual provision. That is why so many of them have been preserved in AHCA, only in a less effective form – leading Rep. Justin Amash (R-MI) to tweet this:

The one Obamacare provision that doesn’t receive high marks from the public is the individual mandate to purchase insurance. In the last Kaiser poll, it only received 35% support. So of course you’d expect the Republican plan to eliminate it. This is the provision they referred to as tyranny and took to the Supreme Court in an attempt to unravel Obamacare.

But a funny thing happened on the way to repeal and replace. As so many have suggested, the only way you make good on a promise to stop insurance companies from denying coverage to people with pre-existing conditions is to require Americans to purchase insurance. Republicans will claim that they got rid of the mandate. But they simply replaced it with a requirement that people have continuous coverage. If you go over two months without it, the AHCA allows insurance companies to charge you an additional 30% on your premiums for a year. Josh Barro points out the problem with that.

But even beyond that, under Obamacare, if you don’t have insurance you pay a penalty to the government. Under the Republican plan you pay a penalty to your insurance company.

In the end, a mandate by any other name is still a mandate. It’s just that Republicans want to enforce that by subsidizing a private entity rather than the federal budget. Nothing in this plan does a better job of defining the difference between Democrats and Republicans than that move.

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.