Can Republicans Tweak Health Care Reform?

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JONATHAN CHAIT JANUARY 24, 2011

Can Republicans Tweak Health Care Reform?

A couple conservatives today propose reforms that would replace the individual mandate with a less-coercive mechanism to prevent people from free-riding their health insurance. Here's Merrill Matthews:

It is important to understand that the mandate is merely a clumsy way to fix a bigger problem in ObamaCare: the requirement that insurers accept anyone who applies regardless of medical condition.

Congress could mitigate that moral hazard by restricting individuals buying their own coverage—employer-based plans already accept all new employees—with a pre-existing medical condition to obtain or change coverage only during a six-week, annual "open season" enrollment period. Or they could pay an increased premium the longer they wait to get coverage, or both. Those options would not eliminate gaming, but they might reduce it.

and here's Ross Douthat:

 One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.

I think these are sensible ideas, if not perfect ones. (Paul Starr's proposal remains the best, and I've never understood why Congress didn't do it in the first place.) The truth is that it would be very easy to tweak the individual mandate to resolve the philosophical and legal objections conservatives have raised. Unfortunately, there's little reason to believe either that these objections represent the right's real problem with the Affordable Care Act or that they're willing to consider any tweak to improve the law.

The conservative base has simply been whipped into such a frenzy on this issue that it's impossible to imagine Republicans making any change that isn't designed to lead to full repeal. There's a reason why conservative magazines and writers keep repeating the slogan "Repeal" endlessly. It's more a point of honor than policy. The Affordable Care Act has become, in the right wing mind, a monstrosity, a completely illegitimate assault on American freedom, and an emotional wound that conservative elites work very hard to ensure never heals.

Of course, it's very helpful for conservative elites like Matthews and Douthat treat the right's objections to the individual mandate (a policy tool Republicans either supported or had little objection to up until 2009) at face value. Eventually conservatives will make their peace with health scare reform, and either put their policy imprint on it or not. But in the meantime the overwhelming conservative impetus is to sabotage the law by any available means. A reform to the law that satisfies objections to the individual mandate, but that does not satisfy the urge to repeal the bill, will be seen by most Republicans as untouchable.

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posted in: jonathan chait, congress, merrill matthews, ross douthat

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