Moderate Democrats Turning Against PPCACA’s Individual Mandate
Four Senators who just happen to be up for re-election next year are silently looking for alternatives to the Affordable Care Act's individual mandate.
Politico notes that several moderate Democrats may pose a threat to the individual insurance mandate in the Affordable Care Act:
A handful of moderate Senate Democrats are looking for ways to roll back the highly contentious individual mandate — the pillar of President Barack Obama’s health care law — a sign that red-state senators are prepared to assert their independence ahead of the 2012 elections.
They haven’t decided whether to propose legislation, but any effort by moderate Democrats that takes aim at the individual mandate could embarrass Obama and embolden Republicans who are still maneuvering to take down the health care law.
And it’s not just health care. The senators are prepared to break with the White House on a wide range of issues: embracing deeper spending cuts, scaling back business regulations and overhauling environmental rules. The moderates most likely to buck their party include Sens. Joe Manchin of West Virginia, Ben Nelson of Nebraska, Claire McCaskill of Missouri and Jon Tester of Montana — all of whom are up for reelection in 2012 and represent states Obama lost in 2008.
The goal is to lay down a record of bipartisan compromises with Republicans, but it could also put Obama at odds with key centrists, right at the moment the president himself is looking to forge a more centrist path.
And their efforts could put Majority Leader Harry Reid (D-Nev.) at a potential disadvantage on key votes. The Senate leader has to protect 23 Democratic seats next year, giving moderates and swing-state Democrats plenty of leeway to prove their independence, but he also has to worry about keeping a unified front for the party ahead of the presidential election. With only 53 Democrats leading the thin Senate majority, if three or four break away on any key issue, Minority Leader Mitch McConnell (R-Ky.) could in some cases claim a simple majority.
Of course, it’s no coincidence that Manchin, McCaskill, Nelson, and Tester would possibly be breaking with their party not only on health care, but also on other issue. Not only are all four up for re-election in 2012, but all four come from states that John McCain won in 2008. Given that the electoral landscape for a Democrat in 2012 in these states isn’t likely to be all that better than it was in 2010, a move to the right on their part is entirely logical, and smart politics. Moreover, the rulings from Judge Hudson in Virginia and Judge Vinson in Florida seem to have given at least some political momentum to the anti-ObamaCare forces.
At the same time, I’m not sure that any of these moves are going to help people like Manchin, McCaskill, Nelson, and Tester electorally. As Greg Sargent notes, their efforts are likely to help undermine the Affordable Care Act, but not enough that it won’t be an issue for their opponent to exploit in 2012. Moreover., it’s unlikely that any of these efforts will actually amount to anything until two things have happened. First, the 2012 elections, and, second, the Supreme Court ruling on the Constitutionality of the individual mandate. The first event, of course, is still 21 months away. The second is unlikely to happen before the end of the Supreme Court’s 2012-2013 term. Until then, this is all political jockeying.
I continue to be fascinated by the posts by James Joyner, Doug Mataconis, and others on the Affordable Care Act. From what I can see Joyner, Mataconis, et al favor “repeal and replace”, with the replacement consisting of tort reform and a drastic reduction of the ability of individual states to regulate the health insurance industry. From what I’ve read the effect of both changes on both the number of people with medical insurance and on insurance costs would be negligible. If I’m wrong on this, I’d appreciate seeing some reference to research on this topic by an objective individual or group. If I’m right, “reform and replace” takes us back to the status quo – hospital emergency rooms carrying out medical procedures they weren’t designed to do, denial of coverage due to pre-existing conditions, recission, annual and lifetime caps on coverage, continuation of the doughnut hole in prescription coverage for senior citizens, and, of course, 30 million people without health insurance. I can’t understand the rationale for preferring this state of affairs, particularly as the number of people without health insurance continues its relentless increase. I wish somebody would explain why so many conservatives feel this way in terms that I can understand.
the big other change is equalizing tax treatment for healthcare whether employer provided or individual. The current system incentives too great a level of health insurance and causes over consumption and incentives R&D over time to not be dirrected in areas that involve lowering costs, becasue providers always know they will get a reimbursment over their costs. If health insurance were more like car insurance, that it only kicked in when catostrophic things happened, there would be a compeditive market now for most health care services and we would see real price declines like we have had with Lasic and cosmetic surgery in recent years.
The Medicare actuary alluded to this in his recent congressional testimony, and the tax distortion is well known about. Friedman wrote a famous article on this in the late 90s and one of the members of Obama’s economic advisory council wrote a paper on this a while back.
One of the major reaosns that healthcare costs and therefore access is limited as much as it is, is because the system incentives over consumption and does not incentivise costs cutting R&D. Change those two incentives and we will have a functioning healthcare system.
If healthcare service inflation over the past 30 of 40 years had been on pace with general inflation, there would be virtually no one today who could nor afford healthcare who was not eligible for medicaid. In addition, disposable income growth would have been higher and the federal and state budgets wouldnt be in nearly as big of a mess. The healthcare bill does nothing to adress any of these things other than a temporary unsustainable coverage expansion.
“Moreover, the rulings from Judge Hudson in Virginia and Judge Vinson in Florida seem to have given at least some political momentum to the anti-ObamaCare forces.”
Sad state of affairs when your party’s “political momentum” comes from a couple of controversial court cases about the legislation you couldn’t stop or ameliorate. It’s the kind of momentum you get walking through snow uphill.
Hell, by Fall 2012 Obama himself will be running against ObamaCare, at least on days in which he’s campaigning in right-leaning swing states.
The mandate is not a necessary part of the ACA. You could get much the same effect with limited enrollment and a penalty for joining late. Free riders would be taking a big risk. The only downside is that we need to have the political will to not provide care to those who refused to participate.
On the replacement part, I am unaware of any actual existent GOP replacement plan. Ryan’s plan was rejected during the HCR debate. I believe the GOP has sent it out to several committees to work upon. I would love to look at any proposals if anyone sees one.
Steve
The mandate is nothing but a means to an end. Even Obama has said he’s open to changes if someone has a better idea for achieving the same goals. But of course, Republicans in the Senate, who claim to believe that the mandate is tantamount to Nazism, have declared they won’t work with any Democrats to improve the bill.
Because that’s how serious they are about governing.
I love this commentary. President Obama gets to use the “no true Scotsman” approach to any proposed alternatives and get what he wants. Brilliant!
There are lots of different proposals that address problems related to the delivery and expense of health care. Imagining that Obama’s is the best or must stand unless some other comprehensive proposal is submitted to accomplish the exact same goals is silly.
“. Imagining that Obama’s is the best or must stand unless some other comprehensive proposal is submitted to accomplish the exact same goals is silly.”
The alternative is a return to the status quo. While it is a mediocre bill in many ways, it does offer increased access and some possible cost savings. The status quo leaves fewer people insured, increasing numbers of people uninsured, increased costs and no means to address Medicare spending. While I suspect that a GOP approach will not work, I could very well be wrong. If they are going to repeal the ACA, or sabotage it, they should implement their own plan as soon as possible. That needs to begin by telling us what that plan is. They have none now.
Steve
They can’t say what their plan is, because they attacked Alan Grayon when he revealed it.
If you get sick and you’re poor, die fast.
Imagining that Obama’s is the best or must stand unless some other comprehensive proposal is submitted to accomplish the exact same goals is silly.
Tell the millions of Americans who will lose their coverage if it’s repealed with no other plan how silly they are.
“They can’t say what their plan is, because they attacked Alan Grayon when he revealed it.
If you get sick and you’re poor, die fast.”
Yeah, remember when Grayson said that and all the self-appointed moderates tut-tutted and scorned him for saying such unseemly things about his “colleagues”. Such brutish and bad-faith slandering of the republicans!
Then it turned out that that was their plan. Of course, the idea that the GOP simply is *worse* than the DNC, and that one party simply is ideological to the point of complete irrationality and destructiveness, is incomprehensible to the equivocators and “moderates”. Making such obvious but contentious judgments is too much for those cowards.
Interesting story over at Politico:
Insurance reality hits House GOP:
“There are lots of different proposals that address problems related to the delivery and expense of health care.”
OK, charles austin, name them.
“Sam, what was the headline in that story? I cannot seem to find it.”
Too dumb to click a mouse?