Public Citizen’s Eagan Kemp joins us as we dive into the history of the individual mandate (spoiler: it’s a conservative idea), why it disproportionately punishes low-income people, and how progressive taxation under a single payer plan would be much more equitable than our current flat premium system. We look back at how such a regressive idea came to be championed by Democrats, and then forward at the continuing legal challenges to the ACA that center around the controversial mandate. If the ACA survives this latest attack, will a Biden administration try to reinstate the tax?

Show Notes

Why are we talking about the "individual mandate" in healthcare? Two reason! 1) The mandate is at the center of a lawsuit challenging the Affordable Care Act, which many are worried may succeed after Amy Coney Barrett tilts the Supreme Court to the right; and 2) Republicans essentially eliminated the mandate back in 2017, and if Democrats retake Congress and the Presidency in 2021, this raises the question of whether Dems will - or should - reinstate the mandate.

We start off by asking Eagan the hard questions: like what the hell is an individual mandate?? It is a requirement that you obtain health insurance, or you face a fine (usually when you do your taxes).

At this moment in our country's political history, the individual mandate is generally supported by Democrats (as personal responsibility and a way to get healthy people to pay into the healthcare system) and opposed by Republicans (as an infringement on personal liberty and the right to choose whether you buy insurance or not). But it was not always so! The individual mandate was originally a conservative proposal - championed by the Heritage Foundation and offered by Senate Republicans as an alternative to Hillary Clinton's health reform plan, which was based on an employer mandate.

How on earth did this conservative alternative to "Hillary Care" become a central plank of the Affordable Care Act (ACA)? First, as Eagan points out, the mandate is beloved by the health insurance industry - it's basically a law that compels people to buy their products, and it's great for profits. The insurers give a lot to both parties, so it's not a shock that both have championed the idea at different times.

The shift from a Republican to a Democratic policy really began in the Massachusetts Health Reform law of 2006 - which became the model for the ACA - and included an individual mandate as a compromise between a Democratic state legislature and Republican Governor Mitt Romney.

Ironically, in the election that followed, Hillary Clinton and John Edwards both supported the individual mandate during the 2007 Democratic Presidential primaries, while Barack Obama opposed a mandate. But it was included in the Affordable Care Act anyway - probably to placate the health insurance industry - at which point Republicans decided it was the devil's work.

It's also important to understand that the individual mandate is a regressive way to pay for expanding health insurance coverage, when compared to creating a new tax and then expanding public insurance coverage. When you pay your Medicare payroll tax, for example, you pay 2.9% of your wages - which will be a high amount for really rich people, and a low number for someone being paid a minimum wage. The individual mandate requires everyone to pay a flat premium, regardless of whether you're a billionaire or just scraping by on a lower income. This is why studies find that Medicare for All would create huge savings for working class and middle class people.

Beyond being a regressive way to pay for healthcare coverage, the mandate is also different from using taxes b...