Imagine it’s 2005, and a top Republican lawmaker boasted about closing Social Security Agency bureaus, making it tougher for seniors to get their checks. Or imagine it’s 2009, and a leading Democrat bragged about cutting supplies for Army units in Iraq, hobbling the war effort.
Well, it’s 2017, and the second most powerful Republican in the U.S. Senate just crowed about how he and his colleagues have wrecked part of the Affordable Care Act, undermining a program that helps millions to get insurance.
The Republican is John Cornyn, from Texas, who is the Senate Majority Whip. He was talking about a provision of the GOP tax cut bill that eliminates the individual mandate, which imposes a financial penalty upon people who do not get health insurance.
The mandate, which took effect in 2014 along with the Affordable Care Act’s protections for people with pre-existing conditions, serves several important functions. Among the most important is encouraging healthy people to sign up for coverage, so that insurers can spread the cost of high medical bills broadly and, in the process, keep premiums more manageable.
The mandate is generally unpopular and, for the people who end up paying it, it can be a real financial burden. But without the mandate in place, premiums will rise for people buying coverage on their own, insurers will be more likely to abandon markets, and the number of people without coverage will increase.
Nobody seriously disputes this. The only question is over the magnitude of the effects.
Cornyn is well aware of this and, judging by comments that Bloomberg Politics reported on Tuesday, it’s the outcome he prefers.
“Arguably, doing away with the individual mandate makes the Affordable Care Act unworkable ― not that it was particularly great beforehand,” Cornyn said. “Hopefully this will precipitate the bipartisan negotiation on what we need to do as an alternative.”
This is hardly the first time a prominent Republican has suggested that a collapse of the Affordable Care Act’s marketplaces would spark a political crisis, forcing Democrats to negotiate with Republicans over crafting a new system. President Donald Trump has made the same argument repeatedly. And although Trump frequently says the program is collapsing on its own without his help, the reality is that his administration has actively undermined the program ― by, for example, slashing funding for enrollment outreach and cutting off a set of key payments to insurers.
These moves have already taken a toll. The number of Americans without insurance, which had reached historic lows, has started to tick back up. Premiums for people buying coverage on their own this year are considerably higher than they would be if not for GOP sabotage. (Charles Gaba, analyst and proprietor of ACAsignups.net, has estimated about two-thirds of this year’s increases are a byproduct of Republican action.)
To be clear, taking away the mandate won’t make the Affordable Care Act truly “unworkable,” as Cornyn says. Millions will still qualify for Medicaid in states that have expanded the program. Millions more will still get comprehensive coverage at affordable rates, thanks to federal tax credits that largely insulate them from rising premiums.
But people who buy coverage on their own and make too much money to qualify for tax credits will have to pay even more for their insurance than they do now ― and it was too much for many of them already. Insurers, most of whom struggled to cover their costs in the first few year’s of the law’s implementation, will be even more likely to abandon it.
It’s of course possible that Cornyn, Trump and their allies are correct ― that by inflicting yet more damage on the health care system, Republicans will increase the public’s appetite for full repeal and weaken Democratic resolve to oppose it.
But the polling on health care has been remarkably consistent over the last few months. For all of the public’s very real misgivings about the Affordable Care Act and its effects, most Americans prefer that the program stay in place. They want Congress to fix its problems, to make coverage more affordable for those struggling to pay for it. They don’t want Congress to take insurance away from millions who have gotten it, which is precisely what GOP repeal proposals would do.
The polls also tell a consistent story about how the public will react if insurance markets continue to deteriorate, so that premiums keep going up and carriers keep leaving markets.