The Tribune Democrat, Johnstown, PA

April 7, 2012

William Lloyd | On ObamaCare, GOP long on criticism, short on alternatives

William Lloyd

— According to the pollsters, two-thirds of respondents oppose the ObamaCare mandate that uninsured individuals buy health care coverage or pay a penalty.

The U.S. Supreme Court may declare this so-called “individual mandate” to be unconstitutional. However, even if the court upholds the individual mandate, the Republican presidential candidates and the Republicans in Congress have vowed to repeal it.

The individual mandate is not part of a “socialist agenda” advocated by President Obama. Rather, the individual mandate originated with conservatives, was a Republican alternative to President Clinton’s 1993 health care proposal, and is a critical element of the Massachusetts plan signed into law by Gov. Mitt Romney. 

Furthermore, during a primary election debate, Romney defended the individual mandate in the Massachusetts law as needed to assure that everyone pays a fair share of the cost of health care.

Opposition to the individual mandate is hard to square with the public’s overwhelming support for Medicare. In essence, Medicare is mandated health insurance for senior citizens. It is financed by taxes on workers and employers and by a premium that is deducted from Social Security benefits.

Workers, employers and senior citizens have no choice in the matter.

Nevertheless, some Medicare recipients vigorously defend the benefits they enjoy because of these mandates, but they then rail against a similar mandate to benefit their children and grandchildren.

Making insurance affordable depends, in part, on collecting premiums from people when they are healthy in order to help pay for care when they are sick. Without an individual mandate, too many people are likely to forgo insurance when they are healthy but then to seek coverage when they have a heart attack or are diagnosed with cancer or some other serious illness.

Historically, insurance companies have denied coverage to uninsured people who already are in poor health or are considered prone to poor health.

One popular feature of ObamaCare bans this insurance company practice. However, if the individual mandate is eliminated, the ban on the denial of coverage will probably also be eliminated. 

Otherwise, insurance companies would almost certainly raise premiums significantly for those who have insurance. 

Higher premiums would likely force employers to increase the share of the premiums charged to employees or to drop health insurance as a benefit.

If the individual mandate and the ban on denying coverage are eliminated, we will have four basic options.

* First, we could retain the system we already have. 

Under that approach, taxpayers would continue to subsidize hospitals for treating the uninsured. In addition, those who have insurance would continue to pay inflated premiums to help provide care for those who do not have insurance.

In theory, each state could develop its own reform, but state budgets are already strapped. Furthermore, it is unclear why an individual mandate imposed by the state government would be significantly more popular than one imposed by the federal government.

* Second, we could deny health care to those who cannot afford it. Although that approach might satisfy some critics of ObamaCare, most Americans would probably find it unacceptable.

However, if that is what the Republicans really intend to propose, they should at least have the courage to say so before the election.

  * Third, we could provide tax breaks and other government subsidies as an incentive for the uninsured to buy coverage.

Although ObamaCare includes such subsidies, it is questionable whether they will be large enough to enable all middle-income families to afford insurance.

In any event, the Republicans insist that the budget must be balanced without a tax increase. Therefore, there is no reason to believe that any Republican proposal for tax breaks and other subsidies would be generous enough to enable most of the uninsured to obtain coverage.

* Fourth, we could expand Medicare to cover everyone and pay for the expansion through higher taxes.

During the debate over ObamaCare, many congressional Democrats supported that approach, but it was dropped because neither congressional Republicans nor conservative Democrats would vote for it.

In view of their opposition to higher taxes, there is no reason to believe that the Republicans would vote to extend Medicare to everyone if ObamaCare is overturned or repealed.

Republicans usually oppose benefits for people who fail to help themselves. Curiously, they appear willing to make an exception in the case of health care.

Unfortunately, they have been long on criticism of ObamaCare but short on realistic alternatives.



William Lloyd represented Somerset County in the state House of Representatives (1981-1998) and served as the state’s small business advocate (November 2003-October 2011). He is a resident of Somerset Borough.

 

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