Individual Mandate

Arizona Health Confusion

Joe Mathews — Sun, 21 Sep 2008 18:26:00 -0400

In drafting ballot initiatives, sponsors often face a choice. They can give their measure a better chance of winning by making it vague. A specific provision is easier to attack. But vague provisions often provoke legal challenges that block successful initiatives from taking effect. Such may be the case with Arizona's Prop 101, the ballot initiative designed to prevent the sort of health care reforms passed in Massachusetts and pursued in California. (Speciifically, the initiative bans the state from requiring people to get health care coverage, and would seem to bar a single-payer system). In this Arizona Republic story on the measure, critics suggest the initiative is so ambiguous that its real meaning might be decided in the courts.

And now the head of the state's indigent care system suggests the initiative, if passed, would force his department to close.

REFORM: Newt Gingrich on "Free Riders" and the Individual Mandate

Elizabeth Carpenter — Wed, 18 Jun 2008 16:05:00 -0400

If you were paying attention to your health care headlines recently, you might have doubled back for a second look at this caption: "Gingrich suggests insurance mandate for some." Huh? Is Newt Gingrich thinking seriously about a requirement to purchase health insurance? Is that a typo? No.

Let's recap. At an Alegent Health event in Omaha, the former Speaker of the House suggested that a strategy to combat high health care costs should include a requirement that people who earn more than $75,000 a year purchase insurance. According to an AP story, Gingrich said it was, " ‘fundamentally immoral' for a person who can afford insurance to save money by going without, then show up at an emergency room and demand free care."

This is in keeping with some Gingrich's past comments about individual responsibility in the context of health reform. In a June 2007 opinion piece in the Des Moines Register, he said:

Personal responsibility extends to the purchase of health insurance. Citizens should not be able to cheat their neighbors by not buying insurance, particularly when they can afford it, and expect others to pay for their care when they need it. However, an individual mandate is an acceptable option only when the larger health-care system has been fundamentally changed. It is unjust to require an individual to buy into a broken and dysfunctional system.

Here's the bottom line from some of our own work at New America on uncompensated care, "free riders," and the uninsured—16 percent of individuals who are uninsured are above 400 percent of the poverty line (about $80,000 a year for a family of four and $40,000 for an individual). They are the classic "free riders"—people who could likely afford insurance, but choose not to buy it. When the uninsured receive care that is not paid for, the insured pay higher premiums as a consequence. Hardly seems fair or efficient.

Gingrich appears to get this, as did fellow Republicans Arnold Schwarzenegger in California, and Mitt Romney in Massachusetts. Romney made the individual mandate central to his state reform proposal while he was governor of Massachusetts, and confronted this issue head on in a Wall Street Journal op-ed, during the heat of the health reform conversations in his state. "Some of my libertarian friends balk at what looks like an individual mandate," he wrote. "But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian."

The reality of an individual mandate (when coupled with subsidies so that insurance is affordable and market reforms so that coverage is accessible), is that it would not only address the "free rider" problem, but also serve as a tool to enhance insurance market competition. When combined with market reforms and subsidies, the mandate would help move insurers away from a business model that relies on marketing and underwriting and towards a strategy that involves competing for customers based on performance and price. This is a good thing...and something those in favor of market competition could get behind.

Thursday Round Up: A Look at a Petition Firm

Joe Mathews — Thu, 17 Apr 2008 18:59:00 -0400

DEPARTMENT OF MOON HOWLING: The Las Vegas Review & Journal takes a long look at one of the country's more important signature firms, National Voter Outreach and its CEO Rick Arnold. I've interviewed Arnold in his Carson City home, and found him to be one of the more thoughtful people in the petition trade, critical of its problems and clear-eyed about its limitations. This story is built heavily around criticism from the liberal/progressive Ballot Initiative Strategy Center, which is quick to lable signature gathering as corrupt (at least in cases where it opposes the cause in question). There is a "shocked, shocked" quality to this criticism. The signature gathering business has plenty of problem workers, many of them poorly trained folks who, for lifestyle reasons, have taken a job that usually pays them in cash. But BISC and other critics invariably propopse to criminalize the process of gathering signatures, as in Oklahoma. In supporting these restrictions, liberals are hurting themselves, by establishing precedents restricting political speech that can be used by their political opponents. And such restrictions don't stop direct democracy. They merely slow it down, adding to the costs (and thus the influence of interest groups) that progressives love to denounce. The more you regulate, the more firms like National Voter Outreach will benefit.

BLOOMIE AND ARNOLD: Mike Bloomberg, deepening his involvement in California initiative politics, hosts a fundraiser tonight on behalf of Gov. Schwarzenegger's redistricting ballot initiative. It's still gathering signatures on the street.

MICHIGAN POT: Medical marijuana initiative makes the ballot in Michigan after legislature declines to adopt the measure itself. (hat tip to Ballotpedia).

INDIVIDUAL MANDATE: A ballot initiative to establish an individual mandate for health care in Michigan is now circulating on the street.

NO ANIMAL CONFINEMENT MEASURE IN COLORADO: Colorado's ballot will be a little less crowded, as animal rights advocates drop their farm animal confinement measure. The state legislature passed legislation similar enough to satisfy the initiative's backers.

OAKLAND YOUTH: Here's an interesting report on a city of Oakland (Calif.) ballot initiative to double funding for a youth services program.

NEVADA NEUTRALITY: School superintendents, never fan of teachers' union, are staying out of a coming mega-ballot war in Nevada over the union's effort to raise taxes on gaming to generate more funds for education.

MAINE DEBATE: A referendum question has been submitted in Maine that would remove "sexual orientation" from human rights and discrimination law, and bar same-sex marriage and adoption by gay couples.

PARENTAL NOTIFICATION: Here's a description of another attempt, via California blalot initiative, to require parental notification for minors seeking abortions. A similar initiative went down in the 2005 special election. Over the past week, I found this initiative was a low priority for the state's signature gatherers. It's pay $1 or less a signature, half the price being paid by sponsors of redistricting, crime victims' rights, and alternative fuel measures.

FROM OVERSEAS: Croatians won't get to vote on their country's decision to join NATO.