Senate tax bill fails individual insurance responsibility Republicans trade health coverage mandate for $338 billion for tax cuts: Our view

The Editorial Board | USA TODAY

Show Caption Hide Caption GOP, Democratic senators spar over tax plan Republican and Democratic Senators sparred over the GOP-backed tax reform plan on Thursday night. Republicans are reworking parts of the plan and are considering limiting some tax cuts to keep a handle on the budget deficit. (Dec. 1)

The Senate tax bill in its final stages of debate has many flaws. But none is more disconcerting — and none represents a more thorough reversal of what used to be bedrock Republican principles — than its ending of the requirement that all Americans have health insurance.

This requirement, known as the individual mandate, is a centerpiece of the Affordable Care Act. Senate Republicans tacked repeal of the mandate on to their tax bill as a way to help fund a host of cuts for corporations and wealthy interests.

It's worth remembering that Republicans were for the individual mandate before they were against it. From 1993 to 2008, they sold it with the argument that individual responsibility, not government intrusion in markets, should be at the heart of any health care reform.

That all changed in 2009 when newly elected President Obama, who had opposed a mandate during the previous year's Democratic primaries, decided that it should be part of his plan. Once Obama was for it, Republicans decided they had to be against it.

OPPOSING VIEW: End the individual mandate

Their original position was the right one. The mandate, which the Supreme Court upheld, is vital to ensure the viability of markets where individuals can buy coverage.

Because issuers would still be required to cover pre-existing conditions and children up to age 26, what insurance company in its right mind would offer policies if consumers could wait until they got sick to buy? Carriers would either pull out of individual markets or jack up their premiums.

If the mandate is ended, the non-partisan Congressional Budget Office estimates that the number of people with health insurance would drop by 4 million in 2019. By 2027, CBO says, 13 million fewer people would have coverage — more than the population of Pennsylvania. Average premiums would increase by about 10%.

Some of the 13 million would be "young invincibles" who think they don’t need coverage. But many would be people who want insurance but can’t afford it or can’t buy it at any price.

The main purpose of ending the mandate is to find $338 billion to partially offset tax cuts. That is not found money. It is $338 billion in subsidies that health care providers won't get when some of the 13 million uninsured start showing up in emergency rooms. Treating those people raises prices for everyone else.

If Republicans had any sense, they'd go back to their roots. This would include support for international trade and balanced budgets, and a lower tolerance for a president who brags about grabbing women’s genitalia. And it should definitely include a personal responsibility agenda when it comes to health coverage.

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