Tuesday’s elections should give serious pause to congressional Republicans considering a measure to repeal a key Affordable Care Act component — the requirement to have health insurance.
In Maine, voters signaled support for the 2010 landmark health reform law by resoundingly approving a ballot measure to expand the Medicaid program. While many states (including Minnesota) have already taken advantage of the ACA’s federal funding assistance to cover more people through this medical assistance program, Maine was one of 19 that hadn’t.
Virginia is one of the remaining states yet to take action. But Democrats’ gubernatorial victory and gains in Virginia’s legislature this week are expected to fuel a push to cover thousands more on Medicaid.
It is frustrating after this wave of support for coverage expansion to watch Republicans seriously weigh a repeal of the federal mandate, a move that would roll back the ACA’s coverage gains. GOP leaders are considering including a repeal in their sweeping tax reform proposals.
Killing off the mandate is not in the legislation yet, though President Donald Trump has called for its inclusion. Among the reasons: It would strike a blow against Obamacare and also provide savings to offset the costs of the party’s deep corporate and estate tax cuts.
But the trade-off is unacceptable. Thirteen million more Americans would be uninsured by 2027 than under the current law, according to a Congressional Budget Office report released Wednesday. Insurance premiums would increase by about 10 percent annually over the same time period for those who buy on the individual market, meaning they don’t get coverage through their jobs or a public medical program such as Medicare.
The savings that Republicans seek would come because the mandate causes some people who might go without insurance to buy it. If it’s no longer against the law to be uninsured, fewer people would tap into the new assistance the ACA provides to reduce monthly premium costs, and the federal government would spend less on these consumer subsidies.
Without the mandate, fewer people would also inquire about their eligibility for Medicaid — which covers the poor, the elderly and the disabled. Therefore, the costs of this program would go down.
In total, the CBO estimates $338 billion in savings over the next decade from repeal. But to be clear, these funds wouldn’t be directly applied to paying down the nation’s long-term debt. Instead, the money would go toward offsetting the cost of a rushed and controversial tax plan.
The coverage requirement has been part of bipartisan health reform plans for decades. The reason: It prevents so-called “free riders” from going without coverage and passing along the costs of their care — which they will inevitably need — to those who do have insurance. Public policy should drive, not discourage, individual responsibility.
Leave the mandate in place.