Tax Bill's Repeal of Individual Mandate Big Loss for Health Care

(Bloomberg View) -- In its failure to repeal Obamacare this fall, Congress should have learned a simple lesson: Americans want the government to see that everyone has health insurance. Instead, the Republican majority tirelessly insists on moving in the opposite direction. Thus, their shambles of a tax bill repeals Obamacare's requirement that everyone have health insurance.

This change would cause some 13 million fewer people to have insurance by 2026. While that's less than the 22 million to 23 million who would have lost insurance had Obamacare itself been repealed, it's a giant backward stride.

President Donald Trump and other Republicans like to point out that the individual mandate is unpopular. Maybe. Nonetheless, it's essential to the effort to keep health insurance affordable and cover as many people as possible.

Keep in mind that, in the U.S., the private insurance market is the mechanism that shares out the cost of health care. The premiums that people (and their employers) pay create pools of money used to finance care. The Affordable Care Act makes this mandatory: Everyone must have insurance -- whether it's an individual policy, one provided through an employer, or a public benefit such as Medicaid or care provided by Veterans Affairs -- or pay a tax penalty.

People may resent being told to buy something. But if they don't buy health insurance, premiums rise for those who do. And taxpayers are on the hook for the emergency care that many uninsured people fail to responsibly anticipate.

Those 13 million people who will go without insurance if the individual mandate is lost can be expected to delay doctor visits, struggle to pay medical bills, and generally experience poorer health, much evidence suggests.

Republican Senator Susan Collins of Maine seems to understand this. She was willing to block the repeal of Obamacare -- but now she says she's willing to see the individual mandate go, if Congress promises two years' worth of other funding to keep premiums down. That might help in 2019, but it would not make up for the loss of the individual mandate in the long run.

Fact is, no workable replacement for the mandate has been proposed.

There's still time for Collins and other reasonable Republicans to grasp this truth, preserve the individual mandate, and keep the U.S. health-care system moving toward its rightful goal of truly universal coverage.

--Editors: Mary Duenwald, Clive Crook.

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