Winning Progressive

Earlier this week, Mitt Romney gave yet another speech in which he promised, if he were elected President, to repeal President Obama’s health care reform law.  Romney’s attack on health care  reform centers on the shared responsibility (or “individual mandate”) provision of the Affordable Care Act, which requires individuals to obtain health insurance. That provision, however, is the critical element that makes all of the other portions of the Affordable Care Act, such as ending abusive insurance industry practices and expanding affordable coverage to 32 million more Americans, workable.

The other provisions in health care reform are so politically popular that Romney and many Republicans have vowed not simply to repeal ObamaCare but to “replace” it, thereby implying that some of those other provisions would be restored even if the Supreme Court were to strike down the Affordable Care Act, or a Republican Congress were to repeal it.  But those same Republicans are being extremely vague about which, if any, provisions of ObamaCare they would actually replace, and news reports suggest that the issue is presenting some serious internal disagreements for the GOP.

This installment of Winning Progressive’s Questions for Mitt Romney series focuses on what Romney means when he vows to “repeal and replace” ObamaCare.  In particular, would Romney propose and actively support federal legislation that would provide any of the following benefits of ObamaCare?

* Forbidding pre-existing condition exclusion policies

* Forbidding annual and lifetime caps on benefits under health insurance policies

* Preventing recissions, which is the industry practice of happily accepting your premiums for years on end, but then finding any excuse to cancel your coverage as soon as you get sick

* Requiring a medical-loss ratio of at least 80%, which means that your insurance company has to spend at least 80% of your premiums on providing you with health care services.  The medical-loss ratio provision of ObamaCare caused health insurance companies to need to refund $1.3 billion to consumers because the companies failed to satisfy the medical-loss ratio.

* Establishing a Rate Review Program that ensures that the health insurance industry has to justify rate increases of more than 10%.  The Rate Review Program in the Affordable Care Act protected more than 1.3 million consumers from unjustified insurance rate increased in the first six months of the program.

* Closing the Medicare prescription drug coverage doughnut hole, which ObamaCare began to close in 2011 and would fully eliminate by 2020

* Eliminating co-pays for preventive care services, such as cholesterol screening, mammograms and other cancer screening, and annual wellness visits.  So far in 2012, 14.3 million seniors have received free preventive care services thanks to ObamaCare

* Requiring insurance companies to cover under their parents’ policies adult children until they reach the age of 26. As a result of this provision, the Affordable Care Act has led to 6.6 million more young adults gaining coverage

* Expanding health insurance coverage to 32 million more Americans through providing tax credits to make coverage more affordable for families earning under $88,000 per year and small businesses, and by expanding Medicaid. As a result, 630,000 uninsured veterans now qualify for Medicaid, and an additional 520,000 can receive subsidized health insurance in the state exchanges.

Each of these benefits of health care reform would disappear if Romney gets his wish of eliminating ObamaCare.  And to date, there is little evidence that Romney would attempt to replace any of these provisions of ObamaCare that would end abusive health insurance industry practices and expand coverage.

Romney’s campaign website claims that he would end discrimination against people with pre-existing conditions, but in reality Romney is proposing nothing more than a return to the pre-ObamaCare system which ensured coverage only to people who had managed to maintain continuous coverage before they got sick. And, of course, without the individual mandate that Romney seeks to eliminate, a comprehensive ban on pre-existing condition exclusions could not work.

The rest of Romney’s health insurance “plan” consists of calls to rely on “free-enterprise” principles and state government to achieve vaguely-described reforms of the health insurance system.  There is absolutely no evidence, however, that Romney would propose to replace any of the significantly beneficial reforms enacted by ObamaCare, or that his “free-enterprise” would achieve any of those reforms.  The question for voters, therefore, is whether they want a President who is committed to ending the important and politically popular benefits provided by ObamaCare.

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Earlier editions of this series include Questions for Mitt Romney on the NRA and guns, Jerry Falwell and Liberty University, Robert Bork, and Ann Coulter.

ObamaCare is, of course, under attack, with conservative activists having taken a constitutional challenge to the law all the way to the Supreme Court. That challenge focuses on the individual mandate or shared responsibility provision of ObamaCare, which requires individuals to purchase insurance and which critics claim exceeds the federal government’s power under the Commerce Clause of the Constitution. As we’ve previously explained, leading conservative federal appellate court judges have already rejected that argument, explaining that the “substantial effects” of millions of people not purchasing insurance until they are sick would undermine the health insurance market that Congress indisputably has the authority to regulate. Winning Progressive believes that the Supreme Court will follow suit, either 5-4 or 6-3.

ObamaCare critics, however, have argued that the individual mandate must be reversed because there is no possible limiting principle to a decision upholding the mandate. For example, in the Supreme Court argument yesterday, Justice Roberts asked whether the government could mandate the purchase of cell phones to ensure that people are able to access emergency services when needed, while Justice Alito offered a hypothetical about requiring the purchase of burial plots because everyone will eventually need them. Similarly, in the New York Times, Ross Douthat suggested that if Congress can require the purchase of health insurance, it could also require individuals to obtain food vouchers or join a grocery club presumably to make food more affordable.

The conservative “lack of a limiting principle” argument, however, fails because it ignores the fact that the underlying regulatory goal that the government is attempting to achieve through a mandate must itself be a proper government goal. In the context of health insurance, there is no reasonable dispute that the government can, under the Commerce Clause, require private insurance companies to provide insurance to anyone who can afford it, regardless of pre-existing conditions. But the only way a system free of pre-existing condition exclusions can work is to require individuals to purchase insurance, because otherwise everyone would wait to purchase insurance until they are sick, which is unworkable.

With regards to purchasing groceries or burial plots, however, requiring grocery store owners or burial plot owners to sell their products to anyone who can afford them does not require a mandate to require everyone to purchase those products. And that is because an individual’s refusal to purchase groceries or a burial plot does not threaten a system that requires grocery stores or burial plot owners to sell to anyone who can afford the product. The only way that an individual mandate to purchase groceries or burial plots they can afford could be necessary to achieve a regulatory goal is if that regulatory goal was to require grocery stores or burial plot owners to provide groceries for free to those who cannot afford them. But the government cannot require that (instead, the government would have to provide such products if it wanted to) and, therefore, a grocery mandate or burial plot mandate would never pass muster.

In short, the conservative claim that upholding ObamaCare would open the door to the government requiring individuals to purchase all sorts of products is grounded in fearmongering, not fact.