Welcome, Mr. Iwry, and thank you for coming in to speak with us today, though I can’t promise you a kind reception.
My Republican colleagues appear to be very upset about this decision, despite its support in the business community. They have decided to use this delay, which won’t hinder the rest of implementation, to target a much more important provision of the Affordable Care Act, the individual mandate. It seems they have discovered in themselves a repressed populism they reserve for the special occasions when it serves their no-tax, no-regulation agenda.
“Repeal and replace" is a great way to tell voters what they want to hear. We’re going to keep all the things you like-covering your kids on until 26, closing the prescription donut hole, and banning discrimination based on preexisting conditions-and get rid of all the things you don’t like: eliminating free-riders and telling employers to pay their fair share. And this is easy to say because they don’t intend to fulfill the “replace" part at all. If they did, they would have to come face-to-face with the hard truth that one makes the other possible. Guaranteed insurance coverage without a mandate isn’t insurance at all. It’s just elective bill payment. Given the opportunity, who wouldn’t put off paying for insurance until they need to use it if they could get it at any time?
Some states have tried to implement reform with all of the benefits and none of the costs. Washington State did so in 1993 with disastrous effects. Without any leverage to bring healthy people onto insurance rolls, only the priciest patients remained and insurers began a financial death spiral.
Under Mitt Romney, Massachusetts got it right. With an individual mandate, employer mandate and subsidies, the uninsured rate was cut to just 5.5%. When the insurance industry had guaranteed customers, it could take everyone without decimating the market. Romney called the individual mandate “the personal responsibility principle," and explained that it was essential to “getting everyone the health insurance they deserve and need."
And while his stance may seem bravely bi-partisan now, we have to remember that the idea of the mandate came from the Right. George W. Bush used it to make his health care proposal work.
In 2000, Representative Jim McCrery, once-Chair of this subcommittee and Ranking Member of the full Ways and Means Committee, as well as a member of the RNCC Executive Committee, supported it. “We need to think of a better way to deliver some health insurance to everybody in this country," he said, “As far as I’m concerned that means an individual mandate."
Gingrich supported it, and, indeed, the then-Republican minority made it the foundation of their alternative to HillaryCare in the 90’s.
And all the way back in 1989, the Heritage Foundation-a think tank no one would accuse of being moderate, much less liberal-released the proposal that some credit as the mandate’s first appearance.
Even President Nixon relied on an employer mandate in his reform plan. Personal responsibility and eliminating “free riders" is usually the hallmark of conservative policy-making.
So after decades of Republican support, what has changed? Republicans know that health reform only works if everyone has skin in the game. At some point I have to ask: Do you want this to work? Do you want to help Americans get affordable coverage? If you won’t accept the Republican ideas in the ACA, what is left?
I never wanted a mandate. Asking the business community to be responsible for covering our insurance doesn’t make the most sense to me. I fought for a single payer system that recognizes that our government has a social and financial stake in the health of our citizens.
But the private-market insurer is the system you fought for. This is the compromise we found. Everyone participates so no one is denied. Endless, futile repeal attempts don’t help anyone, nor do non-existent replacement plans. The American people deserve a health care system that works. Let’s get on with the show and get people the coverage they need and deserve.
