Individual Mandate

2018 MIDTERM ELECTION

Time: D H M S

I've noted before that now that the Republicans in Congress have repealed the ACA's much-hated (but vitally necessary) individual mandate penalty (effective 2019), the odds of it being reinstated at the federal level are virtually zilch. Even if there's a massive blue wave in November and the Democrats are able to retake both the House and Senate, they're extremely unlikely to be willing to face the same type of firestorm/backlash that they did back in 2009-2010 over it.

If you need proof of this, take a look at the "ACA 2.0" bills recently proposed by both the House and Senate Dems. Both versions check a whole bunch of items off of my "If I Ran the Zoo" wish list...but neither one includes restoring (much less increasing) the Individual Mandate penalty at the federal level.

Covered California’s Executive Director Addresses Harvard Study on Impact of Eliminating Individual Mandate on Enrollment and Premium

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,”published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

Last year, in my "If I Ran the Zoo" piece, I stuck my neck out and noted that the single biggest problem with the Individual Mandate isn't that it exists, but that it's not strong enough (conservative healthcare writer Michael Bertaut, who I disagree with on most issues but respect on this topic, also argues that the mandate has never been enforced strongly enough either). Here's what I said at the time:

The reality is that as much as everyone complains about the $695 or 2.5% income individual mandate penalty for NOT having qualifying healthcare coverage, the penalty should really be increased. There, I said it. The problem is that if the penalty is significantly less than the amount that the premiums would be, some people will still decide to eat the tax instead of signing up.

 

NOTE: The last few paragraphs of this post have been reformatted for clarity only.

All of Twitter is abuzz with this tweet (since deleted) by Republican Speaker of the House Paul Ryan:

A secretary at a public high school in Lancaster, PA, said she was pleasantly surprised her pay went up $1.50 a week ... she said [that] will more than cover her Costco membership for the year. https://t.co/yLX1Bod1j0

--Paul Ryan (@PRyan) February 3, 2018

While Ryan deleted the tweet above (fear not...a whole mess of people took screen shots before he did so), he has yet to remove another tweet quoting another passage from the same AP article (I took a screen shot of this one in case he deletes it as well):

“I have heard time and again that the middle class is getting crumbs, but I’ll take it!” https://t.co/yLX1Bod1j0

Welp. The Republicans did it. And later today, barring some dramatic last-minute development, the GOP Tax Scam is gonna be signed into law.

UPDATE: It's done. It passed the GOP House, GOP Senate and GOP House (again). Trump's signing it at any moment.

The GOP Tax Scam does many terrible things, of course, many of which are worse than repealing the ACA’s individual mandate. And even within the healthcare arena, the $25 billion PAYGO Medicare cut caused by the GOP tax scam is arguably more damaging overall.

Still, ACA stuff is my wheelhouse, so I’ll stick to the direct impact the bill (if it does become law) would have on the Affordable Care Act.

Above is the video explainer I whipped up a few weeks ago. It’s long and a bit wonky, but it should give a pretty good overview of the situation.

What about the two “market stabilization” bills that Susan Collins was supposedly demanding in return for her “Yes” vote? Yeah, about those:

 

Welp. There you have it.

It's not over yet, since the House of Representatives still has to vote on the bill again (either as is, or after hashing out the differences between the House and Senate versions of the bill), but assuming the final version of the bill includes mandate repeal and is indeed signed into law, this is what the ACA's 3-legged stool would look like when the dust settles.

Obviously I'll have much more to say about what happened last night soon, but for the moment I'll leave it at this.

As I noted earlier, the price Maine GOP Senator Susan Collins appears to be demanding is passage of the Alexander-Murray stabilization bill and passage of her own Collins-Nelson reinsurance bill. I addressed Alexander-Murray in my last post, but let's take a look at Collins-Nelson:

Collins' bill with Nelson would set aside $4.5 billion over two years to help states establish reinsurance programs. Reinsurance directly compensates insurance carriers for their most expensive customers.

To the best of my knowledge, that's...pretty much all it does: $2.25 billion per year for two years, and then...that's it. If there's more to the bill than that, I'll revise this post, but in the meantime, that seems to be the whole bill.

 

(h/t to nmbrmnstr via Twitter for the heads up)

As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").

It's my understanding that if they can't keep it below that threshold, the bill won't go through for some obscure Senate rule reason or another (although apparently White House budget director Mick Mulvaney also stated that they really don't give a crap whether the mandate is repealed or not as long as the larger bill gets passed, so perhaps I'm mistaken about this? Need clarification on this point...)

Before I get into the meat of the headline, I just wanted to point something out (bear with me, there's a reason for this):

Exhibit A:

  • October, 2013: Several million people receive cancellation notices from their health insurance companies, stating that their current policies will be discontinued effective 12/31/13 because they don't meet the Affordable Care Act's minimum coverage requirements. Much outrage and gnashing of teeth follows because President Obama had repeatedly stated that "If you like your plan you can keep it" (which, as I noted over a year ago, was an absurd thing for him to promise without including any caveats since there's no way of guaranteeing that the company won't go out of business, leave the state or simply decide to discontinue that policy for their own reasons which may or may not have anything to do with ACA compliance).
  • November, 2013: In response to the "You Can Keep It" brouhaha, President Obama and the HHS Dept. announce a 1-year (later quietly extended to up to 3 years) "transitional" policy for non-compliant plans. Some states take them up on it; some don't.
  • July, 2015: Republicans and other ACA critics complain that allowing the "transitional" policy extension is partly to blame for significant rate hikes expected to show up in 2016.
  • CONCLUSION: Damned if you do, damned if you don't.