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  • BIOETHICS FORUM ESSAY

The Insurance Mandate and American Values

In the wake of the passage of health care reform legislation, perhaps no part of the forthcoming law has received as much attention as the individual mandate, which requires individuals to purchase health insurance or face financial penalties. Despite the proven effectiveness of an individual mandate to increase health insurance coverage – Massachusetts (the only state with an individual mandate) reduced its percentage of uninsured by nearly half in one year and now boasts the lowest uninsured rate in the country – Republicans remain pessimistic of both the constitutionality and political validity of such a measure. Although Republicans are standing firm in their opposition to mandates, this appears to be a relatively new phenomenon.

Just last year, Republican Senators Robert Bennett, Lindsey Graham, Mike Crapo, Judd Gregg, and Lamar Alexander cosponsored a health care bill that included an individual mandate. None of these Republicans voted for HR 3590. More recently, Olympia Snowe – long thought to be the Democrats’ closest Republican ally on reform – voted for a Senate Finance Committee health care bill that included an individual mandate, only to later join her party in a roll call vote to challenge the constitutionality of the mandate.

Why are so many Republicans all of a sudden opposed to individual mandates? Perhaps they have turned sour at the thought that Democrats were able to pass landmark legislation that borrowed from their playbook. The ensuing health care reform is after all heavily borrowed from the reform enacted by Mitt Romney, the former Republican governor of Massachusetts, in 2006. Both the national and Massachusetts plan are founded upon the three core principles of mandates, insurance exchanges, and subsidies. Rather than embrace this similar reform proposal Republicans have sought to invalidate the Democrats’ ambitious efforts.

Mitt Romney, now seen as a frontrunner for the 2012 Republican presidential nomination, remained a staunch supporter of individual mandates through the Republican primary calendar. During the January 5, 2008 Republican primary debate in New Hampshire he stated, “I like mandates. The mandates work…. If somebody can afford insurance and decides not to buy it and then they get sick, they ought to pay their own way as opposed to expect the government to pay their way, and that’s an American principle. That’s a principle of personal responsibility.” But now Romney is highly critical of the mandates in the Democrats health care legislation.

Romney and many other Republicans have often invoked the notion of personal responsibility as a core value in their health reform proposals, and yet now that an individual mandate is requiring such responsibility they are up in arms, claiming that the government is getting unduly into the lives of Americans. The individual mandate has the potential to reduce individual costs for insurance through an expanded risk pool of individuals. In conjunction with the insurance exchanges, the mandate would help ensure personal responsibility for one’s health by preventing sick individuals from free-riding within the system or healthy and wealthy individuals from opting out of coverage altogether. Republicans have chosen however to portray the individual mandates as an assault on liberty. But is it?

To answer this question, it is worth considering what implementation of the individual mandate would mean. The mandate requires individuals who can afford health insurance to purchase some minimally comprehensive policy. Individuals will not be liable for compliance if they make less than the poverty level or insurance would consume more than 8 percent of their monthly income. Furthermore, individuals who make less than four times the poverty level will also be eligible to receive subsidized insurance.

Most individuals will not even notice the mandate because they get insurance from their employers. Individuals who are not exempt and choose to go without insurance will face a fine beginning in 2016 of $695 a year or 2.5 percent of their income, whichever is higher.

Many Republicans claim that the mandate is a burdensome tax on hardworking middle class Americans who don’t want to purchase health insurance. However, such a penalty might actually be a smart move for someone who does not want to purchase insurance until he needs it. In comparison to the thousands of dollars required per year to pay for insurance, the fine is relatively modest.

While waiting to get insurance until one is sick would effectively lead to exclusion from coverage in the current health care system, the ensuing prohibition on discrimination based on preexisting conditions would not harm people who choose to wait. They would be able to pay the modest penalty until they decide that they need health insurance coverage, at which point coverage would be more readily accessible.

While many Republicans are up in arms about the potential assault on liberty posed by the individual mandate, those who opt to not purchase insurance and then need it later would benefit greatly from the full package of reforms from Democrats. In a truly free market health care system proposed by many Republicans, such individuals would have a lot of trouble getting to insurance once they become sick.

Politicians are certainly entitled to change positions on policy issues (Barack Obama himself was opposed to the individual mandate during the Democrat primaries), but the timing of such strong resistance by Republicans should be questioned. Republicans have sought to discredit and hack away at one of the most important piece of social legislation in our nation’s history by invoking American ideals of liberty and personal responsibility. However, Democrats have effectively reminded Americans of other enduring national values epitomized in their legislation: justice, fairness, solidarity, and stewardship. It appears to have worked.

The courts and Americans do not appear ready to listen to state attorney generals’ efforts to block implementation of the legislation. Americans are ready to move on. Recent polls suggest that the public is becoming increasingly supportive of health care reform. From March 9 to March 23 public approval of passage shifted from 45 percent to 49 percent, while disapproval dropped from 48 percent to 40 percent.

In the days after reform passed, approval for Democrats in Congress has increased from 30 percent to 36 percent, while Republican support has grown from 31 percent to 34 percent. Americans are tired of the perpetual fighting. It’s time to embrace the possibilities before us and unify behind a vision of affordable health care for millions of uninsured Americans.

Published on: March 30, 2010
Published in: Health Care Reform & Policy

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