As Congress has worked on its various health care bills, a core component in all plans has been the requirement for all Americans to get insurance, or the "individual mandate." Some Republicans are opposed to the individual mandate, including Sen. Olympia Snowe (R-Maine), who wields considerable influence in the debate as the Republican most likely to vote in favor of Democrats' health care plans. Snowe said last week she hopes to revisit the mandate on the Senate floor.
On a conference call with reporters Monday, Sen. Max Baucus (D-Mont.), who led a health care bill through the Senate Finance Committee, defended the individual mandate as a moral responsibility.
"We have to ask ourselves a very basic question: should all Americans have health insurance or not?" Baucus said. "If all Americans are part of the system, we're going to be moving down the road of true health insurance reform."
The senator continued, "Some Americans are rich, some are poor... when it comes to health care reform, everybody's the same. Whether you're old or young, we're all in this together."
However, if Democrats are to keep their commitment to limit the cost of health care reform to around $900 billion without adding to the deficit, they need to find ways to expand coverage that doesn't add too much to the bottom line. And that could mean treating people very differently depending on factors like age or income.
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Baucus on Monday described the different ways Congress could make health insurance more affordable -- and thereby feasibly obtainable -- for all Americans. One way would be to simply increase the subsidies that low- and middle-income Americans will get to help pay for insurance. But as he noted, "we don't want to go much over $900 billion over 10 years."
Another way to make coverage more affordable, Baucus said, is to address "minimum creditable coverage," or the percentage of health care costs that insurance companies would be required to cover. The Senate's current bill would require insurers to cover at least 65 percent of health care costs. Baucus said that could be lowered, but he acknowledged the drawbacks of the idea.
"That's going to make insurance less expensive, however it's going to mean less coverage," he said.
The Senate is also considering a separate "young invincible" policy, which would offer only catastrophic coverage for people 25 years old or younger. Snowe has mentioned expanding that plan to more people, and Baucus brought up the idea on Monday as well.
Leaders in the Senate could also consider simply raising the penalty for people who do not purchase insurance, Baucus said.
"If that penalty is changed that'll have an effect on coverage, too," he said. "There are a lot of moving parts here."