Anti-Insurance Mandate Movement In States Could Kill Reform

Blocking healthcare reform may not be good government policy, but it's great politics. Just ask the five Democratic state senators in Virginia who helped the Republican minority pass a bill prohibiting enforcement in their state of any federal requirement for residents to purchase health insurance or pay a penalty. With Republicans controlling the Virginia House of Delegates, the measure is certain to be approved and signed into law by the state's new Republican governor, Bob McDonnell. Since federal law normally preempts state law, the Virginia statute would probably not withstand a court challenge, in the unlikely event that Congress passes health reform legislation. But that doesn't really matter, because there are legislative proposals in two-thirds of the states to block the insurance mandate from taking effect. If even half of those states follow Virginia's example, it would be the final nail in reform's coffin.

Naturally, Republican legislators have been the force behind these mushrooming state initiatives, which have tripled in number since the election of Scott Brown of Massachusetts to the U.S. Senate. But Democrats in two other states-Iowa and West Virginia-are said to be supporting anti-insurance mandate bills. The disarray of the Democrats is also reflected in the continuing inability of party leaders to gather sufficient votes to pass the national reform legislation. Democratic politicians in more conservative states are apparently betting that they are less likely to lose the next election if they abandon reform than if they support it. But that may be a vain hope for any Congressman who voted for the original House or Senate bills.

While opposition to the reform legislation centers on its expansion of the federal role in healthcare, it is interesting that it is being expressed through resistance to the insurance mandate. After all, the vast majority of people under 65 are already covered through their employers. If the reform bill passed, an expanded Medicaid program would cover uninsured low-income people. So a relatively small percentage of the population would be required to buy coverage, and most of those people would receive government subsidies. Now, as I've pointed out before, those subsidies--especially in the Senate version of the bill--would be insufficient for many families that are uninsured. But the financial aid could be increased-and in any case, the reform measure would guarantee that everyone could obtain insurance, which is not the case today.

So what's really behind the state anti-mandate bills? Aside from the desire of Republican officeholders to augment their power or return to power, many anti-government Tea Party activists also back these measures, and their popularity reflects a growing anti-Washington bias that feeds off the public's revulsion at the bank bailouts and the rapid growth of the federal budget deficit. But at its core, the revolt against the individual mandate has less to do with the requirement itself than with the money required to fund it. Simply put, many people don't want any of their tax money to help subsidize coverage for the uninsured. This despite the fact that when uninsured people go to the ER or the hospital, most of the cost of their care is passed onto the insured in the form of higher premiums.

President Obama has rightly been blamed for inadequate leadership on reform, and he has been trying hard to correct that mistake in recent weeks. But even the man in the bully pulpit can do only so much to counter the massive amount of misinformation that has been disseminated. To save reform, Democrats will have to engage their opponents at the grassroots level, just as Obama's troops did during his campaign.