Why not a "national open enrollment month" instead of an individual mandate?
Elections were held in some parts of the country yesterday, and liberals are crowing. It's easy to make too much of the results - it’s an off-off year, after all, and in most states there were no elections at all - but they are nevertheless discouraging to anyone searching for signs that the Tea Party can compile a governing agenda of enduring popularity. Instead, the evidence suggests that voters think that where firebrand conservatives have taken power, they have overreached. Mainers rejected their Tea Party governor’s attempt to do away with election-day voter registration; Mississippians said no to a measure that would have defined “personhood” as beginning at the moment of fertilization; and Ohioans exercised a “people’s veto” of a law stripping public unions of most of their collective-bargaining rights.
In each case, the vote went resoundingly against the conservative position. Ohio voters, for example, rejected the anti-union law by 61-39 percent.
Yet those same Ohio voters (in a symbolic vote) also rejected, by an even larger margin, the individual mandate to buy health insurance contained within the Patient Protection and Affordable Care Act (PPACA), aka Obamacare. Set aside questions of the mandate’s supposed policy necessity for a moment, and consider only the political realities: In the swing state of Ohio, carried by Obama three years ago, in a year when liberals were motivated to show up at the polls to repeal a deeply unpopular union-busting law championed by a deeply unpopular Republican governor, what percentage of voters raised their hands and said, “Yes, please force me to purchase health insurance?”
That’s got to be worrisome to proponents of the PPACA, who’ve been waiting patiently, but in vain, for the president’s signature first-term achievement to get more popular. Seeking a silver lining, Greg Sargent, a liberal blogger for The Washington Post, notes that “it’s hard to know what a vote on the mandate in isolation adds up to in terms of a rebuke of the health law overall.” But it’s not, really, difficult to discern a popular rebuke of the health law overall when one considers the broader polling, which shows the PPACA getting less popular, not more. Last month, in fact, the law reached a new low in popularity, according to the Kaiser Family Foundation. (The “against it” crowd leads the “for it” folks by a 17-point margin.)
And is there even the tiniest morsel of doubt that the individual mandate is the least popular element of this unpopular law? The question for Democrats is not whether the law is a millstone around their necks but whether it will be big enough to sink their election chances next year (as it did for so many of their colleagues last year), or whether voters will be occupied by more-recent outrages.
Now, as for the policy necessity. Those who say the mandate is necessary to pay for uncompensated care provided to the irresponsible uninsured should know that such care goes primarily to groups that won’t be affected by the mandate: the working poor, most of whom will be covered by an expanded Medicaid, and illegal immigrants, who are excluded from both the mandate and the insurance exchanges. The mandate's real aim is to raise money from the young and relatively healthy in order to expand coverage for other people. (If the premiums paid by those mandated to buy insurance were being spent largely on medical care for those individuals, the value of the insurance would be clear and no mandate would be necessary.)
Those who say it’s impossible to require insurance companies to accept all-comers regardless of health status without requiring everyone to buy insurance (since people could wait until they get sick to buy insurance) should remember that that is precisely what we do in the private employer market, where insurers have long been required to accept all-comers regardless of health status provided individuals sign up during an open-enrollment period.
Instead of mandating an insurance purchase, why not just designate one month each year as National Open Enrollment Month? Everyone would be elgible to purchase insurance during this month, regardless of health status, but woe to those who opt out, then get sick or injured. They must wait until the next open enrollment.
Open-enrollment periods work just fine in the employment market. Why can’t they work for everyone else? Given the political liability the mandate clearly is, you’d think would be trying to answer that question.