Individual Mandates on Health Care: The National Debate and California

[courtesy of California Progress Report]

By Anthony Wright
Executive Director of Health Access California

In the national debate about mandates, many are making mountains out of molehills.

To recap, I wrote on December 1:

"The Los Angeles Times reports on the debate among the Democratic presidential candidates over the so-called individual mandate. It been strange seeing this play out nationally, within the very vague terms of presidential campaign position papers… while we’ve been grappling with the nuts-and-bolts of these same issues here in Sacramento.

"I'm a little confused about the fuss. The three proposals, by Edwards, Obama, and Clinton, are all very similar. Edwards and Clinton are trying to make a distinction with Obama, in that they have a individual mandate, and Obama doesn't. But Obama does not say he oppose the individual mandate--he said repeatedly that he would consider it, but his first goal is to make coverage affordable.

"At the same time, Clinton and Edwards both propose to do similar things as Obama to make coverage affordable, providing certain assurances and subsidies (such as saying that premiums won’t be above a certain level of income.) So there's not much difference in terms of the help actually offered to voters: all would significantly expand public programs, bolster employer-based coverage, and offer new public insurance options for folks.

"When Clinton attacks Obama for not being universal, Obama responds that their proposals aren't either, unless they are proposing onerous enforcement. All three of them rely on automatic enrollment mechanisms, especially at work, to get folks covered. All of them get pretty close to universal.

"So why they are making such a deal about a relatively small items. And if they are going to spotlight their health care plans, why are they having an argument about the burdens, rather than the significant benefits, of health care reform?"

Even though their plans are incredibly similar, Clinton and Edwards are making a big deal that Obama's plan doesn't include one element, an individual mandate, even though he has said repeatedly that he would consider including an individual mandate later.