The Corner

Politics & Policy

The Least Senate Republicans Should Do on Health Care

NR’s editors argue against the repeal-and-delay plan that Senate majority leader Mitch McConnell is once again advocating. Instead, they urge Republicans to pass a scaled-down version of their bill that includes only those items on which they are already nearly unified.

I agree with that, and am writing here just to underline one implication. The Senate Republican bill abolished Obamacare’s fines for people who go without insurance: the “individual mandate” that has been one of the law’s least popular features. Since the bill did not abolish Obamacare’s regulation requiring insurers to treat sick and healthy people identically, the bill had to do something to keep people from gaming the system by waiting until they got sick to buy insurance. (If enough people acted on that logic, insurance markets would unravel.) What the bill did was impose a waiting period before people coming back to the insurance rolls could get a tax credit to help with their purchase. It also made insurance more attractive to young people by allowing insurers to give them larger discounts than Obamacare does.

The Congressional Budget Office has throughout the debate over Obamacare been a strong believer in the power of the fines. It found that abolishing them would within a year cause 15 million people to stop getting insurance (even insurance that would be nearly free to them). But the CBO also found that the Senate bill would leave the individual insurance market stable. Republicans were willing to accept that trade-off. A few Senate Republicans balked at Medicaid reform, but nobody said they could not accept these changes.

At the very least, Republicans ought to abolish the fines this year. That might also involve allowing more price variation by age, imposing the waiting period for the tax credit, and making stabilization payments–that last item being possible to move in separate legislation, as the editorial suggests. If the CBO is right, getting rid of the mandate would mean that 15 million people would, by their own lights, come out ahead.


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