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Sainati: Individual mandate must stay: Let’s pay it forward

Leo Sainati, Assistant Opinion Editor

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The recent tax bill passed by Republicans has been widely analyzed and scrutinized for its impact on tax brackets, incomes and savings, but one of the most important elements of the bill has nothing to do with tax cuts: It’s the repeal of Obamacare’s individual mandate. The individual mandate was an essential part of the Affordable Care Act, which brings healthier Americans into the market to lower premiums for those who are sick. The individual mandate functions by fining Americans who do not have health insurance. When the fines began in 2014, anyone uninsured had to pay a $95 fine or 1 percent of their household income, whichever was greater. By 2016, the full penalty became either $695 or 2.5 percent of income.

Unsurprisingly, this aspect of the ACA drew heavy criticism from conservatives who asserted that it was an unconstitutional breach of power and took away citizens’ individual liberties. Additionally, Austin Frakt, associate professor at Boston University points out: “The cultural climate is very different in other states, I don’t think the individual mandate is going to be strong enough to overcome the cultural resistance in some of the states.” However, the individual mandate was unquestionably effective in achieving its goals, bringing significantly more Americans into the market and subsequently lowering premiums. And the mandate is popular among Americans: A poll by the Kaiser Foundation found in August 2017 that two-thirds of Americans thought the mandate should continue to be enforced.

While it is difficult to parse out the effects of the bill’s individual components, since 2010, 20 million Americans have gained health insurance and the uninsured rate has dropped from 16 percent to 9 percent. The individual mandate has clearly been integral to the ACA’s success in lowering the uninsured rate, and repealing it will have disastrous effects. The Rand Corporation — a bipartisan policy research organization — has projected, for example, that repealing the individual mandate would result in 8 million Americans losing health insurance and raise premiums by an average of 7 percent.

Health care faces an intrinsic dilemma, as the individuals that health care providers need the most are those least likely to buy it. The individual mandate is essential to keep healthy people in the market, so insurance is cheaper for all. As the Rand Corporation explains, “The individual mandate keeps a higher share of younger and healthier people enrolled in the risk pool and therefore helps to cushion against a situation in which a disproportionate number of older, less healthy individuals buy coverage.”

Health care embodies former Clinton Labor Secretary Robert Reich’s narrative of the “benevolent community,” which sees social policies as a way to extend the idealistic supportive local community to a national level. Paying it forward for others is understandably unappealing for those who are healthy, but paying it forward is the cornerstone of social security and numerous other forms of social insurance. In issues such as health care, the needs of the many must be put over the needs of the few.

Since Trump’s inauguration speech, the U.S. has adopted the “America First” doctrine — but this ideology has yet to be reflected at home. The idea of elevating the interests of Americans to paramount importance apparently does not extend to domestic policies. Working for the common good cannot be sustained without a benevolent community. As our country grows increasingly divided, uniting wherever we can is essential. While Obamacare is still the law of the land, repealing the mandate drastically limits its efficacy, forcing sick people to pay more and turning away those who they need the most.

Leo Sainati is a SESP freshman. He can be contacted at leosainati2021@u.northwestern.edu. If you would like to respond publicly to this op-ed, send a Letter to the Editor to opinion@dailynorthwestern.com. The views expressed in this piece do not necessarily reflect the views of all staff members of The Daily Northwestern.

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