Healthcare-Reform Repeal May Be Losing Steam -- And Here's Why

Last Updated Apr 30, 2010 11:49 AM EDT

While a new Rasmussen poll shows that 58 percent of those surveyed support repeal of the Affordable Care Act, only a minority of Congressional Republicans have signed on to any of the three current repeal bills. Why? Because, like the public, Republican politicians are confused about the pluses and minuses of different parts of the legislation. Despite their overheated rhetoric during the reform debate, they know that outright repeal risks throwing out the baby with the bathwater.

This is what the Obama Administration has been counting on all along. The president and his congressional allies expect that, once certain popular provisions of the law kick in, opponents will have a harder time painting the Affordable Care Act as a socialistic assault on Americans' freedom and values. Well, maybe. But the efforts by 14 state attorney generals to overturn the statute and bills in 30 states to ban its enforcement are strong evidence that the battle has only begun.

Of course, certain provisions of the bill, such as closing the "doughnut hole" in the Medicare drug benefit, ending the pre-existing condition exclusion for children, and tax credits for small firms that provide insurance to their employees., will prove hugely popular when they go into effect in June. Other provisions that won't go take effect until 2014 also have public backing. A poll conducted just before the vote on reform showed that more than 70 percent of respondents backed the idea of creating health insurance exchanges for individuals and small businesses. And more than three-quarters of those polled favored insurance reforms, including bans on pre-existing condition exclusions.

What many Americans don't like is the requirement that they buy insurance. In fact, most of the state bills - supported in some states by Democratic as well as Republican lawmakers -- focus on this individual mandate. But without that mandate, along with a requirement that businesses of a certain size cover their workers, we cannot reach near-universal coverage. And, unless that occurs, it's impossible to require insurance companies to accept everyone, regardless of their health conditions. If we did, many people wouldn't buy coverage until they got sick.

Those who oppose the individual mandate say that people aren'tt required to buy other kinds of products from private companies. Well, how about auto insurance? You don't have to buy it, but you can't register a car without it, and in many states, it's illegal to drive without insurance. Similarly, you can't get a mortgage for a home without buying homeowner's insurance. So this is a pretty flimsy argument.

Even so, many people don't like the idea of the IRS collecting fines from people who refuse to buy health insurance. Those fines start out at a modest $95 per person in 2014 and rise to $695 in 2016 or 2.5 percent of income, whichever is smaller. Although many people could afford to pay these fines - and some undoubtedly will, rather than purchase insurance - having the IRS penalize non-purchasers is unpopular.

Economist Paul Starr, writing in the American Prospect last December, proposed a somewhat more palatable approach. He suggested that people who don't buy insurance be barred for five years from receiving government subsidies or being able to get guaranteed coverage. In other words, they'd be in the same situation as individuals are today: They'd have to purchase insurance completely on their own and could be excluded from coverage because of their health status. This would sidestep the financial penalty question and would also prevent people who chose not to buy insurance from getting a free ride at others' expense.

This idea is not part of the current law. But should opposition to the individual mandate swell to unmanageable proportions, it's a concept that Congress might consider in future legislation.

Image supplied courtesy of The Fifth Ape at Flickr.

  • Ken Terry

    Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform.