Howard Dean: Individual mandate will disappear
The individual mandate requiring people to buy health insurance will disappear before health care reform is fully implemented in 2014, Howard Dean said Friday.
The former Democratic Party chairman and vocal champion of health care reform told MSNBC that “by the time this thing goes into effect in 2014, I think the mandate will be gone either through the courts or because it’s unpopular.”
But Dean said he didn’t see this as a problem, pointing to his own state’s health care reforms in the 1990s, which did not include an individual mandate.
“The mandate’s not essential to the plan anyway,” Dean said. “It never was essential to the plan. They did it in Massachusetts and had a mandate, but we have universal health care for kids in my state [Vermont] without a mandate.”
Host Savannah Guthrie pointed out that the White House has been arguing the mandate is necessary because, without it, people would only purchase health insurance when they get sick, but Dean rejected the notion.
“There will be two or three percent of the people who cheat,” he said. “That is not enough to bring the system to a halt and people don’t like to be told what to do.”
Dean’s comments come in the wake of a Virginia judge’s decision earlier this week to allow a constitutional challenge to the individual mandate to go ahead. Legislators in at least 38 states have proposed measures to curb the federal health reform law, with many of the proposals focusing on the individual mandate.
But Dean’s argument that the mandate is unnecessary was challenged by Ian Millhiser, a policy analyst at the Center for American Progress. Responding to Dean’s comments, Millhiser said Dean was wrong that the lack of an individual mandate wouldn’t affect insurance premiums.
Quoting MIT economist and CAP contributor Jonathan Gruber, Millhiser argued that not having an individual mandate would mean people who aren’t sick would see buying health care as a “bad deal” and would wait until they got sick. That, in turn would result in fewer people carrying coverage and higher premiums for those who do. Millhiser wrote:
[S]even states attempted to ban preexisting conditions discrimination without also requiring everyone to carry a minimum level of coverage, and all of them saw their premiums skyrocket. According to a scholarly study of VermontÃ¢â‚¬â„¢s health plan, VermontÃ¢â‚¬â„¢s premiums shot up after it enacted a ban on preexisting conditions discrimination but no mandate in 1993. Between 1994 and 1996, most of the country only experienced single-digit increases in its insurance costs. In Vermont, however, average premiums increased by 16 percent during this same two year period.
In Massachusetts, the one state to enact a minimum coverage provision along with its ban on discrimination, the numbers are very different. There, individual premiums fell a massive 40 percent in the years after MassachusettsÃ¢â‚¬â„¢ minimum coverage law went into effect, while the rest of the nation experienced a 14 percent increase.
Millhiser also argues that the courts may not strike down the individual mandate. If the courts see the issue as being a case of eliminating discrimination against the sick (by forcing insurers to cover them), they could give the government broad leeway to apply the policy in an effective way — including an individual mandate, Millhiser writes.
The following was broadcast on MSNBC’s Daily Rundown, August 6, 2010.