Lisa Murkowski endorses repeal of the individual mandate

For the last several days, there has been more ink spilled about the Senate version of Tax Reform that, as the old adage said, “than Carter had pills.” Perhaps the biggest news is that there may be less damage to the markets, but far less money saved than is touted by the Trump Administration, and that has also had many heads shaking, and tongues wagging, over what was the main selling point touted by the White House, and had Democrats seething.

“In a recent report, Standard & Poor’s estimates that a repeal of the individual mandate would save the government about $60 billion to $80 billion over the next 10 years—far less than the $338 billion that the CBO projected. S&P also predicted that a repeal would increase the number of uninsured individuals by just 3 million to 5 million, while the CBO estimated 13 million,” reported the blog, FierceHealthcare.

On the other side of the political coin, are those that are saying that repealing the individual mandate, has only a minimal affect on whether they will, or won’t buy healthcare, because they need it, and some are young, and some are not so young.

On the GOP side, there are those that want to traverse the divide, and the most prominent seems to be Alaskan Senator Lisa Murkowski, who wrote in an Alaskan newspaper, “I have always supported the freedom to choose,” Murkowski said in an opinion column published a few days ago and now her official stance, the national media reported Thursday. “I believe that the federal government should not force anyone to buy something they do not wish to buy, in order to avoid being taxed.”

She also noted, in an appeal to those who might object, “the repeal of the tax penalty will not take care away from anyone but rather “provides important relief to those who have been penalized for choosing not to buy unaffordable insurance.”

Straight from the Republican playbook, this assertion holds less than it seems, but after being somewhat of a renegade in previous attempts for health care legislation, Murkowski might have felt the need to carry at least some water for the GOP.

Later on she transitioned to a more Solomon-like position when she acknowledged that “The ACA has helped many people in our state, and across the country. There is no question about that.”

She also affirmed what has been previously noted, when she said. “Some people have been able to buy insurance for the first time in their life, mental health and substance abuse coverage is more accessible now, and insurers cannot arbitrarily deny coverage to those with pre-existing conditions.”

Her remarks seem to highlight the dilemma for heavily GOP states such as Alaska and even Maine: their lawmakers cannot ignore the fact that the ACA, colloquially known as Obamacare has helped thousands, but can’t quite step up to the fore, in working with Democrats to fix the problems of both perception, and fact.

One of the less known truths is that the IRS who manages the tax penalty, has been far less aggressive, in collecting than was first thought.  So, when one reads Murkowski’s statement, that “Alaskans paid over $9 million to the IRS under this penalty in 2014, and over $12 million in 2015.  There are Alaskans making the calculated risk to go without insurance and pay the tax,” she said. “Eliminating this tax would allow Alaskans to have greater control over their money and health care decisions,” it has to be taken with a grain of salt.

It’s important to remember that some plans in Alaska are not as plentiful due to the opposition hammering away at the mandates, that were designed to bring younger and healthier people to buy insurance on the marketplace exchanges, something that did not happen in larger numbers; with many of the young today, as in yesteryear, thinking that they were mostly invincible, when it came to health.

But, the biggest myth about their costs has been spread by President Trump himself. To set the facts, in response, The Washington Post, said: “The White House provided us a May 23, 2017, report by the Department of Health and Human Services, showing premium increases for the individual market. It shows the average national premium increased 105 percent from 2013 (before Obamacare’s major provisions took effect) to 2017, from $232 to $476. In Alaska, the average monthly premium increased to $1,041 in 2017 from $344 in 2016 — a 203 percent increase. That is among the highest percentage increases reported between those two years. But buried in one of the footnotes is a disclaimer that the data used in this report do not take into account premium tax credits, that’s a big caveat.”  

Furthermore, they continued, “The reason it’s important to look at how people are affected after subsidies is that on average, eight out of 10 marketplace enrollees receive government premium subsidies, and they are protected from a premium increase (and may even see a decrease) if they stay with a low-cost plan.”

In the end Murkowski favors the Alexander-Murray compromise to help with the copays, and out of pocket costs of the ACA, but offer states the ability to opt out, of certain provisions, now tied to the repeal of the individual mandate.

Taking a different tack are those people that do like the ACA, or  most significantly that it offers them healthcare, which in some cases, they cannot afford. In fact, 60 percent of people who buy their own insurance, receive subsidies, and do so to avoid costly hospital bills.

A recent article in The New York TImes showed, with interviews, of relatively young people quite different beliefs, than Murkowski has espoused. They state that,”People like  Alexia Manon Senior complicate the argument of Senate Republicans who are counting on repeal of the so-called individual mandate to free up hundreds of billions of dollars to pay for an array of tax cuts to corporations and individuals. They are assuming that without a mandate, many people would no longer buy insurance, so the government would spend billions of dollars less on the subsidies the health law provides to help those under a certain income level pay their premiums.”

So what is the truth? A wise woman once said that it lies in the middle of the two poles, yet with details emerging, it seems, much to the horror and bemusement, of our Canadian neighbors, that it might just be movable, like the unlucky Linus as Lucy once more snatches the ball away at the last minute.

According the Kaiser Family Foundation, only seven percent of people said that would go without coverage if the mandate were no longer enforced.  But, what many are worried about is market stabilization, but if we believe the earlier figures, then the market would stabilize, or at least not  as unstable, as previously thought.

The KFF also found that while most people hated the thought of the mandate, at first blush, when they were told what what it would do, and who it would help they changed their minds, showing that opposition to the ACA, a longheld obsession with the GOP is based on misinformation, in some cases, deliberate.

One effect that most can agree on is that those who would depart the exchange would see a decreased presence by major insurers, and this would weaken the choice that so many toute, was lost with the ACA, or those that are ardently seeking affordable health care coverage, as both KFF and the AAA show.

Also on Thursday, “If the Affordable Care Act’s individual mandate is repealed as part of a Republican tax cut plan, premiums will likely rise and insurers will exit the individual market, according to the American Academy of Actuaries, reported the American Enterprise Ideas.

“In a letter to Senate leaders Mitch McConnell, R-Kentucky, and Chuck Schumer, D-New York, the actuaries warned that without an incentive to obtain coverage such as the mandate, healthier customers would exit the ACA exchanges, leaving a higher-risk pool which is more expensive to cover—a problem the ACA exchanges have already struggled with even with the mandate in place,” they reported.

“Eliminating the mandate without implementing an alternative means to drive enrollment among healthy individuals would likely result in a deterioration of the risk pool due to lower coverage rates among lower-cost individuals,” wrote Shari Westerfield, vice president of the academy’s health practice council.