What happens when you take away the individual mandate?

 A companion piece to the Podcast.

This started during the Presidential Debate on the 29th of September.  They were arguing about health insurance coverage, and VP Biden mentioned that Trump wanted to take away the health care of 20 million by getting rid of the Affordable Care Act (ACA).  If there was a fact check simply on that, it would be 

MOSTLY FALSE.  as while the President did want to repeal the ACA, he also wanted something to replace it, and stated so from the beginning, specifically to protect those with pre-existing conditions.  Of course if POLITIFACT did the fact check it would have ruled it as:

MOSTLY TRUE. 

So I posed the research that I did as part of my Political Science Capstone Class (emphasis Healthcare).  I went to Healthcare.gov, and followed step by step.  I used my new income as a federal retiree, so as to make sure that if I were eligible for subsidies to lower the cost, they would be applied. (I wasn't)  Here is what turned out.

The cheapest plan, a Bronze Plan, was $1,000 a month for the family premium, with a flat $13,000 annual deductible.  In other words, if I were to go to the doctor for anything but preventive stuff, it would cost me full price, until I hit that deductible.  So $25,000 a year.  That is what VP Biden called insurance, what I could potentially lose, if Trump took it away.

That was when I was asked what kind of plan or reform I think would work.  What an awesome question.  Obviously I thought so, as I am dedicating a blogpost and podcast to it.  Here is why it is so important.

It is very likely that the ACA is going down this year.  Yes.  And it won't be Trump.  And it won't likely matter if Amy Coney Barrett is confirmed or not, though she probably will be.  You see...

When the ACA was sold to the people, we were told that paying the Individual Mandate, the penalty for not buying insurance, though required, was Constitutional under the Commerce Clause.  However, the Supreme Court ruled in NFIB v Sebelius 567 U.S. 519 (2012) that the individual mandate was Constitutional under Congress's authority to levy a tax.  

Guess what went away in 2017?  

In the Jobs and Tax Cut Act of 2017, to get it through both Houses of Congress, the Individual Mandate was eliminated.  No mandate, theoretically, no ACA.  

Republicans since 2010 were saying "give us the House and we can repeal the ACA", when that didn't work, as it couldn't, in 2014, they said "give us the Senate, and we will repeal the ACA".  Again, without a 2/3rds majority to override a Presidential Veto, no way.  Finally, in 2017, with the House, Senate, and White House, the opportunity to eliminate the ACA  was at hand, and the Republicans proved  they were no different  than the Democrats when it comes to size and scope of government.  In December of that year, when the Mandate was repealed, the timebomb started ticking.  

Enough history.  Sort of.

The health care thing is so screwed up right now, that nothing will be done, and we could literally end up with a VA for all, if it comes crashing down like it should this December. (Ironically, the Supremes hear oral arguments on the ACA the week after Election Day, the 10th.  While I would prefer that the government get out of health care, it may need to fix what it screwed up first.

My reform is not mine, and I want to give full credit to where it belongs.  When Senator McCain ran for President in 2008, he had a plan that would likely have helped.  His plan was to create a high risk pool that would be managed by the Federal Government.  This pool would be funded in part by a tax on premiums, and perhaps by a tax on the insurance companies.  

By creating this high risk pool, and setting conditions that it would cover, it lowers the actuarial tables substantially, resulting in much lower premiums.  Eliminate requirements for people to get a "one size fits all" health care plan, letting people pick what they want.  Young and in good health?  Maybe a catastrophic plan would be what you want.  An elderly couple?  Likely no need for prenatal care, like the ACA mandates. 

The reason that premiums are so high (as opposed to the $2,500 per family reduction that was supposed to happen) is that young people who are needed to balance the actuarial tables were either riding their parents plan, or just chose to not be insured.  After all, if you are guaranteed insurance, why buy it until you actually need it.  So who bought it?  Older people, and those with health issues, and of course the pre-existing conditions.  That is why premiums are so high.  

There are many other things that can be done to reduce the cost of care, while making it accessible to more.  When the ACA collapses, someone will need to do something.  The President has tried his entire term.  The GOP didn't when they held the House, and the Democrats, with the timebomb ticking, have done nothing about it.  Blame Trump.  Blame the Republicans.  That is all we will hear.  How about blame DC?

Did I mention that PolitiFact's lie of the year for 2013 was "If you like your Doctor you can keep your doctor."?  That was Biden's boss's lie.  When he complains about the millions that could lose their care with the fall of the ACA, someone needs to ask about the millions that lost their doctors, and their plans because of the ACA.