Former Speaker of the House Newt Gingrich (R-GA) is backing away from his support of the individual mandate and has posted a YouTube message to supporters clarifying his opposition to the mandate provision included in the Affordable Care Act. In an interview with the Wall Street Journal, Gingrich also explained that states could adopt a version of the policy which “could be designed in a way that would be acceptable to libertarians—for instance, people could agree to post a bond that would pay for unexpected health care costs if they don’t want insurance“:
“I think we have to find a way to hold people accountable for paying for their health care,” he said. He told the Journal that the rules should apply to all Americans, but suggested they could be designed by the states.
Romney and the Heritage Foundation advocated a very similar version of the “personal responsibility” requirement. As health policy expert Emma Sandoe has pointed out, under their initial proposal, if a person failed to purchase insurance they would be required to spend $10,000 in the form of a bond that could be used to pay for hospital care down the road. To Romney, this idea ensured funds were directed back into health care rather to the government revenue.
But charging a flat fee regardless of income means different things to different economic demographics and would significantly disadvantage middle class families — who would have to set a side a huge amount of money for a rainy day. The bond wouldn’t provide adequate coverage for a catastrophic health care event — a heart attack could cost up to $1.5 million — and would bankrupt middle class families. It would also do little to increase access to prevention and other services that could deter expensive chronic conditions.
The mandate penalty in the Affordable Care Act takes some of these affordability concerns into account and requires those without coverage to pay a tax penalty of the greater of $695 per year or 2.5% of household income.