Sen. Hillary Clinton's exit from the presidential race will deal a blow to supporters of a key element in the tussle over universal health coverage: the idea that all Americans be required to buy or have health insurance.
That mandate has been an important tenet of Sen. Clinton's health-care plan and the only substantive difference from Sen. Barack Obama's health policy. As a major sparring point in debates between the two Democratic Party candidates, it has become a dominant issue in the national discussion over how to expand coverage to the country's nearly 50 million uninsured.
But with Sen. Clinton failing to secure enough delegates for the nomination, the concept of a broad insurance mandate lost its most prominent platform. For the remainder of the election season, at least, it is likely to fade from the national stage.
Sen. John McCain, the Arizona Republican awaiting his party's formal nomination, opposes the idea of government requiring people to buy insurance. And, while Sen. Obama hasn't ruled out mandates as an option down the road, the Illinois Democrat argues they are ineffective without first making insurance plans affordable.
"Neither of the two presidential candidates still standing believes it's necessary," said Robert Laszewski, a health-care consultant and analyst in Washington. "So we're not going to have anyone talking about it."
After gaining considerable political ground, especially at the state level, the concept has suffered other setbacks lately, too. Despite years of entrenched political opposition to the idea of a mandate, it was a key part of the 2006 universal health care legislation enacted in Massachusetts and of California Gov. Arnold Schwarzenegger's plan to overhaul health care in that state.
The Schwarzenegger plan, though, failed this year, in part because unions and business groups objected to its individual and employer mandates. In Massachusetts, results have been mixed. While the overall plan has cut the number of uninsured adults in that state by roughly half, the state authority responsible for overseeing the program has exempted nearly 20% of uninsured residents because it has deemed they can't afford the policy premiums on offer.
As budgets become more strapped, other states are shifting to less-costly approaches to revamping health care. Last month, for instance, Florida's legislature approved a plan to let insurers sell bare-bones policies with the aim of lowering the cost of individual health insurance.
Mandates aren't likely to vanish from the public conversation altogether. Sen. Obama does support a mandate that all children be provided with health insurance. His proposal also requires that insurance companies be required to take all applicants, regardless of how sick they may be -- a position, many insurers argue, that can work only if everyone is required to have some sort of coverage.
Nor has Sen. Obama entirely ruled out an insurance mandate. His camp argues that reducing costs and making health-plan premiums affordable would be more effective in expanding coverage than would mandating health insurance with the threat of sanctions.
But once that is achieved and there is still a small percentage of people who elect not to buy insurance, "maybe [a mandate] is something you look at," said David Cutler, professor of applied economics at Harvard University and senior health-care adviser to Sen. Obama. But "it's very clear that if it's not affordable, then people won't buy it."
0 comments:
Post a Comment