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September 26, 2013 3:55 PM What the Mandate Ultimately Means

By Ed Kilgore

Since we’re talking about Republican demands for a delay in the Affordable Care Act’s individual purchasing mandate today, it’s useful to look at a reminder of what’s at stake, via Charles Pierce’s interview with MIT economist and RomneyCare architect Jonathan Gruber:

Gruber shares my amusement with the fact that the Republicans are all in favor of those parts of the law that poll really, really well — the protections for folks with pre-existing conditions, the ability of kids to stay on their parent’s insurance until they’re 25, and the ban on lifetime caps — but have announced their unyielding opposition to all the provisions in the law that make those things possible, specifically the individual mandate. This, he reminds us, hearkens back to the golden days of St. Ronnie, who told us we could have a massive tax cut, a massive military spending spree, and no cuts at all in the programs we love because…sparkle ponies!

Actually, I think we know by now that when Republicans say they want protections for people with pre-existing conditions, they do not mean banning descrimination, but simply offering the withered booby prize of state-operated high-risk pools, typically high-cost, low-quality insurance ghettos for those “losers” who didn’t take care of themselves or pile up vast savings. But anyway, back to Gruber:

“The analogy I like to use is a building that’s burning down. The number of people covered by employer-based health-care plans is dropping by a percentage point a year. The system is falling apart. So you put in a new safety net. That means a few more people are going to come in. If you’re not willing to risk making some things worse, you’re never going to make anything better. My estimate is that 80 percent of the people are not going to feel any change at all, and that 17 percent or so are going to find that things are better, and that about two or three percent will be worse off, and those are the people who benefit from the discriminatory nature of health-insurance at the present time. If health-insurance companies can’t discriminate any more, those people will have to pay a little more. When we decided that people couldn’t discriminate in what they paid black people or women any more, people had to pay more because employers couldn’t discriminate in what they paid black people and women. Was that a bad thing?

Without the mandate, the “people who benefit from the discriminatory nature of health -insurance” will be fine, but everyone else will pay a lot more. That, of course, will unravel political support for health reform generally, which is the whole idea.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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