Obamacare’s Individual Mandate Is No Big Deal. But Something Else Is.

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As Republicans go about their plans to repeal and replace Obamacare, attention is now turning to the second half of that mantra: what will they replace it with? Oddly, this is not something that Republicans have come to a consensus on even though they’ve had seven years to do it. It’s almost as if they never had any intention of replacing it in the first place.

But that’s just me being cynical. There may not be any consensus, but there are Republican plans out there. Andrew Sprung rounds up a few of them and concludes that one particular piece of Obamacare shouldn’t cause any real trouble:

One change that need not be too disruptive, I suspect — if done right — is replacing the individual mandate with continuous coverage protection — that is, protection from medical underwriting for anyone who maintains continuous coverage.

“If done right” is doing a lot of work in that sentence, isn’t it? But that’s just me being cynical again. So let’s get serious. Is Sprung right?

Yes he is. The details get a little complicated—click the link if you want to dive into them—but the “individual mandate” is nothing more than an incentive: buy insurance or else you’ll pay a tax penalty. Likewise, “continuous coverage” is an incentive too: buy insurance or else you’re going to be screwed when you get sick and no one will sell you a health care policy. Both are ways to motivate young, healthy people to buy coverage and help subsidize all the old, sick people like me. Honestly, the biggest difference between them is semantic: “mandate” just sounds a whole lot more coercive than “continuous coverage.”

So sure, there are more ways to skin the incentive cat than a tax penalty. But I think we’re putting the cart before the horse here. We really ought to be talking about something else: the pre-existing conditions ban. Unlike the individual mandate, which affects the federal budget and can therefore be repealed by a simple majority, a repeal of the pre-existing conditions ban can be filibustered. That means repeal requires 60 votes, and that means Republicans can’t repeal it. But if it’s not repealed, Republicans can’t do much of anything else. As long as the ban is in place, any Republican plan is almost certain to cause total chaos in the health care market.1 It would be political suicide.

So if Republicans want to do something that’s not political suicide, they need Democratic votes. And that means Democrats have tremendous leverage over the final plan. They can either negotiate for something much better than what Republicans are proposing, or they can simply withhold their votes and leave Republicans between a rock and a hard place: either abandon Obamacare repeal, which would enrage their base, or pass a plan that would cause chaos for the health care industry and for millions of registered voters. This is not leverage to be given up lightly.

1If you don’t understand why, shame on you! My blogging has been in vain. However, Jon Gruber explains it here. Also, check out conservative Michael Cannon at National Review. He gets it too. The pre-existing conditions ban is the key roadblock in the way of Republicans repealing Obamacare.

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WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

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