Remember when requiring people to buy health insurance was a big issue, not for Tea Partiers in 1776 garb, but for Democratic primary voters--and remember how President Obama opposed it, using the issue to separate himself from Hillary Clinton in the health-care policy sphere?
Iowa Sen. Chuck Grassley, the top Republican on the Senate Finance Committee (where so much of the health-care reform debate played out last year), reminds us of this history in light of today's ruling, by a federal judge in Virginia, that the individual mandate is unconstitutional.
From Grassley's office:
President Obama staunchly opposed it as a candidate for President. The concerns he raised then became more clear as the reform debate unfolded, including enforcement. Health insurance companies lobbied for the mandate, which drives billions of tax dollars in new subsidies directly to them.
From President Obama, at a debate with Clinton in February 2008:
Senator Clinton believes the only way to achieve universal health care is to force everybody to purchase it. And my belief is, the reason that people don't have it is not because they don't want it but because they can't afford it.
The individual mandate isn't something that President Obama came up with; nor was Clinton out on a limb in supporting it in 2008. In the last push to reform health care, just three years ago (not nearly as big a push as the one Obama undertook), the idea garnered Republican support. The Healthy Americans Act, proposed by Oregon Democrat Ron Wyden and Utah Republican Bob Bennett in 2007, was built on the notion of this tradeoff: To get insurance companies to cover more people (thereby delivering "universal health care"), the bill required more people to buy insurance.
Under the Obama law, too, that's the basic mechanism by which coverage theoretically will be expanded.
Without the individual mandate, insurance companies say they can't afford the new requirements for whom they must cover. If the government requires them to cover patients at a presumed loss, the expanded pool of customers makes up for it.
Hence some of Clinton's frustration in debating this point with Obama. She had contemplated this broad tradeoff in expanding coverage, and had deemed it necessary. Obama, on the other hand, came out ahead politically, simply because no one likes to be forced to buy something.
His talking point--that the problem with health care is affordability--resonated, but as we found out when the new health care law was crafted, the individual mandate is tied to affordability after all.
Without the individual mandate, affordability is threatened if the insurance market (i.e., the profit analyses by which insurance companies determine prices) tell insurers that, with fewer healthy customers, they need to charge more in order to come out ahead.
The broad skeleton of health care reform, as it was conceptualized in Congress, is significantly compromised if this particular ruling (and two others have upheld the law) is the one that stands.
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