The Successful Mandate in Massachusetts

Posted on June 20, 2012 at 9:11 am by Bob Cesca

In conjunction with the state’s healthcare reform law, he health insurance mandate implemented by Mitt Romney in Massachusetts has been wildly successful. Here’s Sarah Kliff:

Over the course of five years, insurance coverage in the state has increased, premiums have decreased and virtually everyone has abided by the new requirement. While public opinion is favorable – two-thirds of Massachusetts residents support the law – the state does face challenges ensuring that the law is affordable.

The state’s expensive premiums have to do with a 1996 law that banned the denial of coverage for people with pre-existing conditions — and, of course, that was passed without a mandate. Since the mandate, premiums have dropped. The mandate and pre-existing conditions are inseparable.

Strangely enough, Romney currently wants to keep the pre-existing conditions language of the ACA while repealing the mandate. Idiot. Regardless, the Supreme Court might beat him to the punch as early as Thursday.

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  • GrafZeppelin127

    When the Supreme Court strikes down the ACA next week, it will signal the end, once and for all, of any chance that the United States will ever pursue universal medical coverage at the national level. Any chance for universal coverage, if it even continues to exist at all, will lie with the states from that point on.

    We all know that the ACA is a conservative law. The Supreme Court is about to scuttle the most conservative means possible for pursuing universal or quasi-universal medical coverage, because it has liberal/Democrat/Obama cooties all over it. Not only will this leave conservatives and Republicans out of ideas on how to pursue universal coverage, it will be wrongly perceived as a victory for, and vindication of, conservatism (not to mention the Republican party). If anyone thinks this country will ever move to the left of the ACA on health care after this, they are sadly fooling themselves.

    The ruling will also have the potential to put whatever programs already exist that attempt to provide some form of public or universal medical coverage. A ruling based on federalism, that narrows the Commerce Clause and/or the Necessary and Proper Clause, placing new restrictions on their scope or taking them back to pre-Civil War interpretations, could put Medicare and Social Security in jeopardy. A ruling grounded in substantive due process, resurrecting Lochner and its freedom-of-contract doctrines, would invalidate Romneycare and any other state-level medical-insurance mandates.

    Moreover, the ruling will put an end once and for all to any perception that the Supreme Court is an apolitical branch of government, and usher in an era where the Court will be expected to pursue and effectuate the political agenda of whichever party appointed the majority of the justices; a sort of un-elected super-Congress with no accountability to the voters.

    Striking down the ACA will help Romney win the election, to be sure, and will probably help Republicans take the Senate and solidify their majority in the House. No one realistically believes that President Romney or his Congress will do anything to expand access to medical care to more Americans than currently have it, let alone those who will lose it when the ACA is struck down. You can’t get to the right of the ACA and still pursue universal coverage. Maybe the states will step up and do something, but our national health care policy as of this time next week will be: Keep the uninsured, the poor, illegal (read: non-white) immigrants, and other undesirables out of the health care system, and erect whatever legal barriers are necessary to keep them out.

    • muselet

      I’m either a lot more optimistic or a hell of a lot more cynical than you.

      If the Supremes strike down the ACA, we’ll have maybe ten years before the entire health insurance system (ha!) collapses. Costs will become unsustainable, insurance companies will fail and the big hospital corporations will find their profits in free-fall because no one will be able to afford their services. The states won’t be able to afford to do anything.

      At that point, the states, the hospital corporations and the public at large will be beating down the doors of Congress, demanding sustainable, national, universal medical coverage. And with a little luck, we’ll end up with something like the French system.

      The problem is making sure we’re all healthy enough to make it through the next decade or two.

      (Or we’ll be back to leeches and poultices. One or t’other.)

      –alopecia