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Individual Mandates Not Up For Debate

Les Masterson, for HealthLeaders Media, September 3, 2008

The two major presidential candidates' healthcare proposals are quite different, but there is agreement on one issue—they both oppose individual mandates.

Sen. Barack Obama's health plan includes mandatory coverage for children, expanding public programs, mandating large employers offer insurance, and stopping health plans from denying coverage to those with preexisting conditions or charging them substantially higher premiums.

Sen. John McCain bases most of his healthcare policy on market forces and individual insurance as he would offer a tax credit to help Americans pay for healthcare. He also supports health savings accounts, allowing interstate insurance purchases, and less comprehensive health insurance options (known as "mandate lite" policies).

The individual mandate idea ended nationally the day Sen. Hillary Clinton dropped out of the Democratic race for president. The mandate was a major plank in Clinton's healthcare reform proposal, and is a key reason why the commonwealth of Massachusetts has the lowest percentage of uninsured residents—yet there simply isn't widespread support for the idea.

Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority in Boston, which oversees the landmark reform program, says other states and federal legislators are waiting to see what happens in Massachusetts before deciding on an individual mandate.

"The jury is not completely in on [individual mandates]. I think that no matter what your initial thinking is or perspective is on the individual mandate, you would want to see how it played out in Massachusetts," he says.

Kingsdale says the individual mandate allows the state to enroll more residents and encourages people who would not normally sign up for health insurance (young and healthy) to enroll in employer-based insurance. Bringing the younger and healthier residents into the care pool, employers and individual health insurance plans would have more funds to help fund care for the sick.

Kingsdale says the latest figures from March 31 show that about 5% of Massachusetts residents are uninsured. Out of the 439,000 residents who gained insurance since the reforms took effect, Kingsdale says nearly half of them are covered under private insurance. Many of those 191,000 people would not have insurance if not for the mandate, he says.

"I think it goes back to the mandate. I think clearly the folks look at the offer of insurance from their employer very different. And because the mandate and the reforms have made direct purchase insurance far more affordable, we have seen a big increase, almost a doubling, in the number of people buying directly out of their own pocket in the last year," says Kingsdale.

Despite Kingsdale's pronouncement, there are still many who believe individual mandates aren't the way to go. The opponents are groups not usually known as allies. The Cato Institute in an April 2006 policy analysis called "Individual Mandates for Health Insurance: Slippery Slope to National Health Care" wrote an individual mandate would create a "costly and complex bureaucratic system of tracking, penalties, and subsidies" leading to an unenforceable mandate.

The think tank added mandates would lead to more regulation and interference of healthcare choices, which would lead to a path to a "government-run" healthcare system. On the other end of the political spectrum is OneCareNow.org, a California advocacy group promoting a single-payer system. The group wrote on its Web site that individual mandates are "a cruel method for pretending that health insurance is on the way for everyone while, in fact, bigger profits are on the way for insurance companies."

Whether individual mandates are the answer is still in question. It won't be part of the national debate during the presidential campaign. Instead, the debate will focus on whether the U.S. wants more government intervention or consumerism. We may have to wait another four years before the individual mandate makes another appearance on the national stage.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .


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