Yale political scientist and health reform expert Jacob Hacker has written an important post untangling the confusion many feel in the back-and-forth between Clinton and Obama over health care (read it here). Hacker explains how the virtually identical structure in both candidate’s plans have been hidden in the vitriol over their modest differences:
So what’s the main story: (1) a basic Democratic consensus about what should be done, or (2) a widening policy divide fueled by presidential ambitions? The answer is (1), but unfortunately, the reality of (2) is increasingly upstaging this welcome development. And, unfortunately, this unnecessary and self-defeating conflict could ultimately derail efforts at reform, confusing and turning off the very voters Democrats need to woo.
The bitter Clinton vs. Obama public argument over the individual mandate leads people to compare their plans to Massachusetts health reform. But both plans are quite different than chapter 58:
Massachusetts has taken a very different route than Senators Clinton and Obama envision. Massachusetts basically adopted an individual-market model: People without coverage from their employer need to actively seek it out. The cornerstone of both candidates’ plans, by contrast, is the play-or-pay requirement: employers cover their workers, or their workers are automatically enrolled in a single insurance pool to which employers are required to make contributions. …
Done correctly — with businesses reporting whether they cover their workers to the federal government, which then enrolls uninsured employees and their dependents — a play-or-pay requirement makes covering people much less complicated. The more than 90 percent of non-elderly Americans (and more than 80 percent of the uninsured) who live in a family in which someone works would be enrolled automatically through the workforce. Many of those missed are already covered through public programs, and aggressive outreach could reach those who still remain without coverage. Thus, Mr. Obama’s plan could well cover almost everyone even without the individual mandate.
Last week the campaigns continued their health care attacks (see this Obama ad and this Clinton response. Hacker urges the candidates to focus on affordability, enrollment strategies, and how they would provide portable health security to everyone.
Brian Rosman
I live in MA and do not have insurance. My husband’s employer pays 30% of an insurance that we cannot afford. The connector is also not affordable to us.
We cannot afford the nearly $200 a week for the employers insurance nor the $400 a month for the cheapest connector.
We do not qualify for state insurance due to the employer offering the subsidized insurance.
Isn’t that a pickle?
Thank you for the straight to the point overview of the policy being presented. I, as well as many Americans, become a bit overwhelmed with the bickering over the little points of the policy, that we tend to miss the big picture of the policy being presented. While the MA healthcare policy accomplished great feats, it has it’s downfalls. The current plan at MA continues to create hardships for small businesses, creates little burden on large businesses, and misses a segement of the population. The play-or-pay approach seems intriguing, and it will be interesting researching the details of the logistics of the proposed policy.
I think our nation should do what MA has done with health insurance and mandate it. The current problem with MA current system is that insurance companies are required to do bussiness in MA, and the good companies haven’t returned to MA. If all states had the same laws simalar to MA, then insurance companies have no choice to compete in all states without hurting the economy.
Thank you very much for this information. It seems like the Massachusetts mandates are one of the more problematic components of our law. It’s good to know that Clinton’s plan does not rely on this.