Early this evening, by a 187–230 vote, the Congress rejected a Republican effort to strip the individual health insurance mandate from the new health care law. Twenty-one Democrats crossed party lines to vote in favor of the measure, while one Republican, Rep. Joseph Cao (R-LA), voted against it. The effort was led by Rep. Dave Camp (R-MI), who attempted to attach the measure to a motion that would have sent a small business tax credit bill back to committee with instructions to insert language invalidating the measure.
Camp claimed that the mandate violated “the basic principle of freedom and individual choice.” “No American should be forced to buy or purchase health insurance they don’t want or can’t afford,” Camp said, arguing that the measure would “uphold the freedom upon which this nation was founded” and obfuscate the need for more IRS agents. The Democrats’ argument was far less grand. Ways and Means Committee Chairman Sander Levin (D-MI) pointed out that the individual mandate was birthed by Republicans in 1994 and that removing the measure now would only increase premiums for families and undue the new insurance market reforms:
LEVIN: Colleagues, individual responsibility is the cornerstone of health reform is to ensure that every American has affordable health insurance coverage. And that’s why it was included in the GOP 1994 reform. So this is nothing more, nothing more, than a disingenuous political stunt to undermine health reform. Without individual responsibility it would mean that we could not eliminate exclusions for pre-existing condition. We could not prohibit insurers from refusing to cover someone when they apply. We could not prohibit insurance companies from charging more when you get sick. And according to the CBO, if this were to pass, it would result n a loss of coverage for more than 16 million Americans…it would raise health insurance premiums for every American buying coverage through the exchange by nearly 20%.
Watch highlights from the debate:
Indeed, in 1993, Sen. John Chafee (R-RI) introduced an alternative health care bill that compelled every American to purchase health insurance coverage. Four current Republican Senators including, Hatch, Grassley, Bennett, and Bond co-sponsored the measure — and for good reason. The individual mandate creates incentives for otherwise healthy Americans to purchase insurance and may be the only way to achieve affordable universal coverage. Without a mandate, only the sick who need health care would be motivated to purchase it. The pool of insured would be weighted with sick individuals, forcing the costs of the premium to escalate. According to a study by MIT economist Jonathan Gruber, “a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion.” As Paul Krugman concludes, a plan without mandates would cost $4,400 per newly insured person, the plan with mandates only $2,700.
As Levin points out, the mandate is also essential for reforming health insurance markets. Demanding that insurers accept every applicant without regard for pre-existing condition and charge every beneficiary a community rate is impossible if healthy people game the system and wait until they fall ill to purchase coverage. Under the GOP’s scenario, why would anyone spend their healthier years paying insurance premiums if the neighbor across the street can obtain the same coverage for the same rate on a need-it-now basis?