Republicans are responding to the Supreme Court’s ruling upholding the individual mandate by constructing a new “death panels”-like lie. The law, they argue, imposes a burdensome tax on millions of middle class families who will have to pay a penalty for not purchasing health care coverage by 2014. The line originates in the majority’s decision, which found that Congress has the authority to require individuals to buy coverage under its taxing power, but it doesn’t mean what the Republicans are suggesting.

The truth is that the penalty for not buying insurance — $695 or 2.5 percent of household income — is well in line with other policies that are designed to encourage and promote a particular kind of economic behavior. On Friday morning, NBC’s Chuck Todd compared the penalty to a speeding ticket and asked House Majority Leader Eric Cantor (R-VA) to distinguish between the two taxes. Cantor could not:

TODD: On the tax front quickly, is a speeding ticket a tax? By that same definition? You can avoid paying this tax if you get insurance. [...]

CANTOR: First of all, let me — I can’t respond to whether the speeding ticket would be considered a tax or not under the states’ authority any states’ authority. What I can tell you is the court came down on this issue decided that it was a tax to coerce some type of behavior.

Watch it:

In the case of health care, the law is offering an incentive for younger and healthier Americans to purchase health insurance coverage before they fall ill and pass on the costs of their treatments on to the government and other premium payers. Widespread take-up of coverage could cut government expenditures on uncompensated care in half. As Mitt Romney explained in 2006, “I don’t think the free market ever envisioned an idea that people would be able to do something and make other people pay for it.” And after successful implementation of reform in Massachusetts, few are.

On the federal level, the Congressional Budget Office is projecting that 30 million Americans will enroll in insurance as a result of the law, millions more will receive a tax cut to help them afford coverage, and of the remaining uninsured, “the majority of them will not be subject to the penalty“:

21 million nonelderly residents will be uninsured in 2016, but the majority of them will not be subject to the penalty. Unauthorized immigrants, for example, are exempted from the mandate to obtain health insurance. Others will be subject to the mandate but exempted from the penalty—for example, because they will have income low enough that they are not required to file an income tax return, because they are members of Indian tribes, or because the premium they would have to pay would exceed a specified share of their income (initially 8 percent in 2014 and indexed over time). CBO and JCT estimate that between 13 million and 14 million of the uninsured in 2016 will qualify for one or more of those exemptions. Of the remaining 7 million to 8 million uninsured, some individuals will be granted exemptions from the penalty because of hardship, and others will be exempted from the mandate on the basis of their religious beliefs. [...]

After accounting for all of those factors, CBO and JCT estimate that about 4 million people will pay a penalty because they will be uninsured in 2016 (a figure that includes uninsured dependents who have the penalty paid on their behalf).

Real world experience suggests that Americans are more likely to purchase insurance than pay the penalty for going without coverage. For instance, in Massachusetts, the only state with an insurance mandate, less than 1 percent of the state’s residents paid the penalty in 2009. Surveys of the uninsured have also found that an overwhelming majority — 76 percent of the uninsured — would rather comply with the individual mandate in the Affordable Care Act and purchase insurance than pay the far less onerous penalty for forgoing it. Experts believe that “health insurance mandates differ from some other requirements, such as the requirement to pay taxes” because “enrollees individually receive a tangible good–health insurance—that they value.”

House Minority Leader Nancy Pelosi (D-CA) doubled down on the importance of the individual mandate Thursday morning, just days before the Supreme Court is expected to rule on the constitutionality of the Affordable Care Act.

“You have to have the mandate for [health reform] to work from a financial standpoint,” Pelosi told reporters at her weekly press conference, implying that some Democrats may advocate for a mechanism that requires individuals to purchase insurance even if the existing provision is ruled unconstitutional. “I believe the court will rule in favor. We’re iron clad constitutionally, we’re iron clad on the constitution,” Pelosi — who has long maintained that the Court will uphold the law in a 6 to 3 decision — said, but noted that it would be difficult to retain some of the law’s popular provisions in the absence of the individual requirement:

PELOSI: You have to eat your vegetables — you have to have the mandate in order for this to work from a financial standpoint…If Americans like the idea that they and their children cannot be deprived for a lifetime of health care insurance because of a pre-existing health care condition, then that will require some other action if that is to happen. And what would that be? There could be something passed in the Congress, similar to what we had originally in the House bill, which was a surcharge on the wealthy to pay for aspects of that … States can take their own actions … We cannot say to the American people, we are going to throw you on the mercy of insurance companies who refuse coverage to you.

Watch it:

“Let’s hope and pray that the Court will love the Constitution more than it loves broccoli and that we will have a decision that is based on the merits and the Constitution of the United States,” Pelosi concluded.

Her tone is a stark contrast to the stance of some Democrats who have hinted that they will stress the law’s other benefits should the court invalidate the unpopular individual requirement.

After pledging to fully repeal Obamacare for the last two years, a growing number of Republicans have expressed support for maintaing some of the law’s most popular provisions if the Supreme Court overturns the measure later this month. Health insurers UnitedHealthcare, Aetna, and Humana soon followed suit, pledging to keep children on their parents’ health care plan until age 26, maintain a ban on lifetime maximums on most benefit payouts, and provide some preventive care at no additional cost.

ThinkProgress spoke with several major health care insurers to see where they stood on maintaining other key parts of Obamacare and found limited interest in preserving the measures that could potentially drive up costs if there is no individual mandate adding healthy people into insurance pools:

– UNITED HEALTHCARE: The company “said it can’t cover children with pre-existing illnesses unless other insurers also agree to cover them, and that it would work with “all other participants in the health- care system.”

– AETNA: “[W]e recognize that the ACA has propelled interest in exploring new ways to deliver care. We believe that our work to collaborate with providers, such as Accountable Care Organizations, is key to building a more effective health care system. We are committed to leading the way in delivering solutions that transform our system and deliver on the goals of reform.”

– CIGNA: “Cigna believes in respecting the court’s process. We remain focused on our global customer programs, and are prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion.”

– HUMANA: “We’ll have additional comment (beyond the statement we sent out yesterday) after the Supreme Court issues its ruling.”

Republicans are already pointing to the industry’s announcement as proof that the private market has somehow reasoned out health care reforms on its own, conveniently ignoring the industry’s multi-million dollar effort to prevent the measures from becoming law in the first place.

And while insurers’ willingness to maintain these measures is a good start, they would do little to help the millions of Americans with pre-existing conditions find affordable covrage or reduce health care spending.

– Steven Perlberg

Mitt Romney confirmed on Tuesday that he would allow insurers to deny coverage to millions of Americans with pre-existing conditions if the Supreme Court strikes down Obamacare later this month. During a speech at Con-Air Industries in Orlando, Florida, the former Massachusetts governor said that Americans who have not been “continuously insured” would not be protected from discrimination if they suffer from pre-existing conditions:

ROMNEY: So let’s say someone has been continuously insured and they develop a serious condition. And let’s say they lose their jobs or they change jobs or they move and go to a different place, I don’t want them to be denied insurance because they have some pre-existing conditions. So we’re going to have to make sure that the law that we replace Obamacare with, ensures that people who have a pre-existing condition, who have been insured in the past, are able to get insurance in the future so they don’t have to worry about that condition keeping them from getting the kind of health care they deserve.

Watch it:

While the Affordable Care Act would prevent insurers from denying coverage to anyone with a pre-existing condition beginning in 2014, Romney’s provision is far more limited — and would only protect Americans who already have coverage.

As The New Republic’s Jonathan Cohn has pointed out, the federal government already forbids insurers from denying coverage to the continuously covered through the 1996 Health Insurance Portability and Accountability Act (HIPAA). But the measure has been seen as a failure because “there is no limit on what insurers can charge under HIPAA” and the law does “little to regulate the content of coverage, leaving the door open to insurers to offer bare-bones policies. In addition, HIPAA notice requirements are weak, making it hard for people to know about this protection.”

Romney could offer to bolster the existing law, but given his general laissez-faire approach to health care and opposition to “government interference” in the private sector, it’s unlikely that he would want to impose new regulations on insurers. Without a mandate for everyone to purchase coverage, the protection would also attract sicker people who need care and increase premiums for all enrollees. In other words, it’s a poor solution that will leave millions still searching for coverage.

The Wall Street Journal has uncovered a collection of emails from Mitt Romney’s time as Governor of Massachusetts that reveal a lot about Romney’s changing positions on health care. Most notably, they show the now-candidate once was a staunch defender of a health reform law with an individual mandate — a portion of the Affordable Care Act that he often criticizes.

Indeed, in an original draft of a famous op-ed Romney ran in 2009, the Governor even used what are now the President’s talking points:

According to the emails, Mr. Romney personally drafted an op-ed article published in The Wall Street Journal the day before he signed the legislation. The draft, written on a Saturday, also defended the individual mandate, in different language from the final version of the piece as published.

Using an argument deployed today by the Obama administration, Mr. Romney defended the mandate by noting that taxpayers generally foot the bill when the uninsured seek health care.

“Either the individual pays or the taxpayers pay. A free ride on government is not libertarian,” the published op-ed stated. In a line that didn’t make the edited version, Mr. Romney added: “An uninsured libertarian might counter that he could refuse the free care, but under law, that is impossible—and inhumane.”

During this election season, Romney has said he would strike down Obamacare — a federal replica of his state plan — but may preserve some of the portions of the law intact. That is in itself a change from his 2010 position that the nation should adopt an individual mandate. But these emails reveal that Romney did not just consider an individual mandate useful to Masscusetts, he considered it essential to a functional health care law — precisely what the Supreme Court is now debating.

The individual mandate is the most controversial part of the health care law, despite the fact that several top Republicans once supported it. But a new report indicates that its impact will be less far-reaching than opponents have claimed.

The Kaiser Family Foundation released a study last month examining how many people would have to buy health insurance or pay a penalty under the mandate. In addition to Americans who already have insurance through their employer or other means, who would not be affected, the foundation also noted that the law offers a variety of exemptions for people facing hardships:

The mandate’s exemptions cover a variety of people, including: members of certain religious groups and Native American tribes; undocumented immigrants (who are not eligible for health insurance subsidies under the law); incarcerated individuals; people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples); and people for whom health insurance is considered unaffordable (where insurance premiums after employer contributions and federal subsidies exceed 8% of family income).

In simulations prepared for Kaiser, Jonathan Gruber of the Massachusetts Institute of Technology estimates that about 40% of those who would be uninsured in the absence of the ACA would be exempt from the mandate. That means almost 9 in 10 non-elderly people would either satisfy the mandate automatically or be exempt from it.

While some polls show opposition to the mandate, most people support it when they learn that coverage offered by their employer would satisfy the requirement. Studies also indicate that an overwhelming majority would rather comply with the individual mandate and purchase insurance than pay the far less onerous penalty for forgoing it.

-Zachary Bernstein

EDITOR’S NOTE: ThinkProgress has launched a special webpage devoted to the Obamacare lawsuit before the Supreme Court. Please check it out here. We will be updating it periodically as developments occur.

This week, the federal government will appear before the Supreme Court to argue for the constitutionality of the Affordable Care Act’s individual mandate. The government will maintain, in part, that requiring everyone to purchase health insurance can eliminate “free riders” from the health care system and lower the nation’s spending on uncompensated care.

Interestingly, Mitt Romney has made the same argument since he mandated health care coverage in Massachusetts and continues to echo these claims in his presidential bid. So here — in one video — is Romney making the Obama administration’s policy case for requiring everyone to purchase insurance:

During an interview with American Public Media’s Marketplace, President Obama defended the individual health insurance mandate and reiterated that likely GOP presidential nominee Mitt Romney enacted a very similar policy as governor of Massachusetts. “[W]e designed a program that actually previously had support of Republicans,” Obama told host Kai Ryssdal, “including the person who may end up being the Republican standard bearer and is now pretending like he came up with something different.”

Obama also predicted that the Supreme Court — which is scheduled to hear oral arguments on the constitutionality of reform on Monday — will uphold the law and that “it will be very hard for any governor to explain why it is that they’re not giving people…an opportunity to get cheaper health insurance, better deal, more protections because of some ideological argument that they’re having with the president.” “And when people see that in fact it works, it makes sense — as it’s, by the way, working in Massachusetts — then I think a whole bunch of folks will say ‘Why aren’t we trying it as well?’” he added. Listen: