It's no secret that Republican politicians don't like Obamacare. Thus far, the Affordable Care Act - passed in 2010 - has survived congressional gridlocks, state refusals to expand Medicaid coverage, and a constitutional case in front of the U.S. Supreme Court. This week, the U.S. House of Representatives is voting on yet another bill created to slow the progress of Obamacare.
Known as the Mandate Delay Act, this bill would postpone by one year the date on which all Americans must have health insurance. When the Affordable Care Act was passed in 2010, the law stated that starting January 1, 2014, all Americans would be required by law to hold a minimum level of health care coverage. This requirement is known as the individual mandate. As Obamacare stands at the moment, starting in 2014 any American without health insurance will have to pay a fine, or what some lawmakers call a tax on the uninsured. This uninsured person's tax will start at $95 for 2014 for a single person, and increase to $695 in 2016.
There are many reasons for creating this individual mandate and tax, requiring every American citizen to carry a minimum level of insurance. To begin, uninsured Americans cost everyone else money. When a person without insurance visits the doctor (or more often the emergency room) and fails to pay in full, hospitals lose money and the result is higher insurance premiums for everyone. A 2009 study released by the group Families USA found that uninsured Americans had an annual unpaid health bill of over $40 billion; a cost that was shifted on to insurance holders by way of higher premiums. What's more, Americans without insurance will often put off visiting the doctor until an emergency situation has arisen; at which point the patient's condition will be usually worse and the cost of care greater. If this uninsured patient had been required by law to hold health insurance, he may have visited his doctor sooner, saving himself and the hospital money and greatly increasing his chances of getting healthy sooner.
However, plenty of Americans (especially conservative voters and Republican politicians) are opposed to the government mandating any purchase of health insurance. Voters and politicians alike may feel that health insurance is simply unaffordable for some Americans, and that the ACA's individual mandate will punish low-income citizens. Many Republicans, suspicious of federal involvement in health care legislation, may also feel that the government shouldn't be evaluating insurance and deciding what does and doesn't qualify as a minimum level of care - that's a job best left to private industry. And, for other Americans opposed to Obamacare, the individual mandate is just another cog in the bureaucratic, expensive and unworkable wheel of the ACA.
Conservative politicians are hopeful that the Mandate Delay Act will be well-received in Congress, and that individuals will be given until 2015 to purchase insurance, because the Obama administration itself has already delayed similar coverage requirements for employers. Earlier this month, a statement from the White House announced that large employers - those businesses with 50 or more employees - don't need to provide their workers with a minimum level of health coverage until January 1, 2015. Originally, these large employers were required to meet ACA requirements on January 1, 2014 - the same date upon which the individual mandate comes into effect. Because the employer mandate has been postponed one year, Speaker of the House John Boehner (R-OH) and other Republicans have said it's only fair that the individual mandate be put on hold as well.
The Obama administration, however, has argued that there is no need to delay the individual mandate. Online health insurance marketplaces are scheduled to open this October, at which time subsidies and premium credits will also be available to help low and middle-income Americans purchase insurance. If the marketplaces are open and the cost-assisting subsidies in place, why delay the mandate? The financial assistance created by the ACA should mean that all Americans can afford minimum coverage by 2014; the subsidies and premium credits will be available to any American with a salary of up to 400 percent of the federal poverty level, which means that even an individual living on $40,000 per year may be eligible for reduced-cost insurance. Most of all, the Obama administration has been adamant in its defense of delaying the employer mandate: the White House has said that its postponement of the workplace coverage requirement shows an important level of flexibility in the law, and is not (as some Republicans have insinuated) evidence that the Affordable Care Act is unworkable or that the bill as a whole should be delayed or discarded.
When the House of Representatives votes this week on the Mandate Delay Act, it will represent the 38th time that the House has initiated debate on an act to postpone or abolish the ACA. Just this May, the House was presented with H.R. 45, a bill from former presidential candidate Michelle Bachman that would repeal Obamacare in its entirety. That bill passed the House of Representatives by a vote of 229 to 195, and is currently on the calendar of the U.S. Senate. Of course, if the House of Representatives is bothering to discuss and vote on the Mandate Delay Act, then clearly nobody is expecting Bachmann's bill to pass a vote in the Senate.
All of these votes, discussions, delays and repeals demonstrate the extent to which the Affordable Care Act has become significant to not just health care, but politics as well. As the vote for the Mandate Delay Act goes forward, it will be interesting to note to what extent opinion divides along party lines, and how far politicians are willing to go to put the breaks on the ACA; an act that has already survived more than 37 attempts at impediment.