After all the storm and stress over the efforts to repeal Obamacare this summer – successive failures on repeal-and-reform, straight repeal, and even skinny repeal of what is formally known as the Patient Protection and Affordable Care Act– the repeal of one key aspect of the Obamacare package slipped through almost as an afterthought to the major tax overhaul this week.
At the time of this writing the repeal of the individual insurance mandate is part of the Tax Cuts and Jobs Act passed by both Houses of Congress. That Act, and thus the repeal, still awaits re-passage by the House of Representatives (necessary due to an issue of parliamentary procedure) and then POTUS’s signature.
The individual mandate is the rule that individuals not otherwise covered, who fail to maintain insurance coverage for themselves, must pay a tax penalty. The Congressional Budget Office estimates that in 2019, the first year in which such coverage will no longer be mandated, about 4 million fewer people will be insured than would have been had this provision remained in place.
The individual mandate has two purposes. One is frankly paternalistic. Some people who don’t have insurance are gambling recklessly, and the Congress in effect decided when it passed Obamacare that they should be forced to get insurance for their own good. But the second purpose of the mandate is systemic. Healthy people who pay insurance premiums are paying into a system that in turn makes the pay-outs to those who do need care. By choosing to stay uninsured in larger numbers they will be draining the pool. In the language of the original bill’s title, then, “patient protection” and “affordable care” respectively are these two purposes of the mandate.
There are of course, different ‘takes’ on the individual mandate and its demise. In contrast to some of the other issues we’ve discussed recently in these columns, this one breaks down pretty well on traditional left/right lines.
Left Wing View
John Fugelsang, a Sirius XM host, tweeted out his own farewell to the individual mandate on Wednesday morning, December 20: “Created by a GOP think tank. Implemented by a GOP governor. But then the black POTUS adopted it & it had to go.”
This is a reference to the fact that an analogous system, including an individual mandate, became the law in Massachusetts in 2006, with the signature of then-Governor Mitt Romney. Romney wasn’t merely the figurehead who signed the bill after others drafted it – rather, the Governor’s office was active in the whole legislative process, and Romney personally pressed for the individual mandate as a component.
Fugelsang is no admirer of Romney’s. Indeed, he is the host who, during Romney’s campaign for the presidency in 2012, got an advisor to Romney’s campaign to refer to the candidate’s variability on many issues as that of an ‘etch a sketch.’ The point of Fugelsang’s tweet, and a sentiment shared by many on the web of late, is that through President Trump’s malign influence, (or under the influence of racist resentment of the “black POTUS”) the Republican Party is turning against its own better ideas and impulses.
On the left, too, one often encounters an analogy between auto insurance and health insurance. No one has a right to drive a car without proper liability insurance. Likewise (because of the predictable impacts on other people), the argument concludes that no one has a right to run the risks of going uncovered for possible medical costs.
Right Wing View
The right is very vocally happy to see the individual insurance mandate shuffle off into the history books. A typical tweet reads, “Removal of the individual mandate does NOT mean you lose your health insurance. You’re just not FORCED (mandate) to buy it.”
Breitbart ran the following headline in red Wednesday morning, at the top of its home page, “TRUMPMAS EVE: SENATE PASSES HISTORIC TAX CUTS AND JOBS ACT,” with logo-sized Christmas trees at both the beginning and the end of the headline.
Two weeks before, the same site carried a lengthy piece by John Nolte arguing that enacting repeal of the insurance mandate would be “the most important civil rights victory in years.”
Nolte takes specific issue with the auto/health insurance analogy. “If I purchase a car,” he writes, “I am voluntarily taking on certain civic responsibilities that require the purchase of insurance. I have no problem with that [but] … for no other reason than the fact that I am born, the [health insurance] mandate is the federal government forcing me to buy something.”
But now Patterico, on RedState, makes the point that repealing the individual mandate by itself is a poor excuse for a more thoroughgoing repeal of Obamacare as a system. “Obamacare’s dog’s breakfast of mandates will never be a sustainable, functioning mechanism, and removing one mandate does not solve the problem of skyrocketing health care costs and rising premiums. It will almost certainly make it worse.”
That will serve as our last word.