Reconciling our past and embracing the individual mandate

There are some things in this world I will never understand. Who thought the traffic circle made any sense? What flavor is ‘oriental’ Top Ramen? Where’s Waldo? When did it become acceptable to leave your shopping cart in the middle of the supermarket parking lot? And why, for the love of God, won’t the Republicans support the individual mandate?

In broad strokes, the individual mandate is a provision of the Affordable Care Act (ACA) that requires almost all Americans to carry health insurance (exemptions include things like financial hardship). If you don’t buy insurance, you will be penalized on your taxes. The fee, beginning in 2014, will be the higher of either one percent of your household income or $95 ($47.50 per child under 18) per person for the year. You may think these penalties are pathetically weak relative to the annual cost of premiums (they are!), but that is the topic of another conversation.

Sure, on the surface it makes perfect sense to oppose the mandate. Like any good Republican will tell you, we don’t need any more of Obama’s big government telling us what to buy or how to live. By definition, an individual mandate takes away some of our personal freedom because it does away with choice. Beyond the moral opposition, some people on the right oppose the mandate because of the burden it imposes on certain segments of the population. Although the law is called the Affordable Care Act, health insurance is still expensive, and forcing some people to buy it could create financial hardship (that doesn’t qualify for the exemption). Last but not least, Republicans laid their cards on the table and called the mandate unconstitutional. This claim was, however, rejected by the Supreme Court in June 2012.

Upon further excavation into the depths of individual mandate history, we begin to uncover an inconvenient truth: the mandate was originally a Republican idea.. Way back in the political stone ages of 1989, the Heritage Foundation released a brief called “Assuring Affordable Health Care for all Americans.” In it, the individual mandate served to counteract the employer mandate and the idea of universal coverage—key policy ideas coming from the left. Four short years later the Republicans put forth the Health Equity and Access Reform Today Act of 1993. The act garnered enough support from the right to be co-sponsored by 18 Republican members of Congress. You’ll never guess how they proposed to make sure everyone ended up with health insurance—that’s right, the individual mandate. Fast forward to the first decade of the 2000’s for one of the most recent, and perhaps most shocking, examples of Republicans championing the individual mandate. It was 2006 and the Republican Governor of Massachusetts passed a comprehensive healthcare reform bill that included the individual mandate. What’s more, his plan largely served as the basis for the ACA, better known by that fear-mongering term ‘Obamacare.’ (Cue growls and hisses from the peanut gallery.)

Now you may be asking what’s so great about the individual mandate. But if both sides wanted it at one time or another, there’s got to be something logical about the policy. Well, there is! Insurance—and health insurance is no exception—is based off of the idea of pooling risk. That is to say, some people in your risk pool will get really sick over a given coverage period and require huge outlays in claims while others won’t get sick at all and you’ll get to keep virtually all of their premium payments. To calculate premiums, an insurer aggregates the expected outlays across all of its policyholders and divides to determine what each enrollee needs to pay in premiums. The more people in the risk pool, the more stable it will be over time because larger populations have less statistical variability in their health. In short, the individual mandate helps insurers pool risk because all the healthy people are required to sign up for insurance.

To conclude, why can’t the two parties in our system synchronize their affinity for the individual mandate? Without sounding too much like this generation’s broken record of punditry, I offer that our partisan—and toxic—political climate stands as an impenetrable barrier between smart minds and the obvious solution.

Oh, and did I mention that the Republican governor from Massachusetts was Mitt Romney, the presidential candidate in 2012 who ran, in part, on dismantling the Affordable Care Act?