Streams

Opinion: Each State Should Remix their Health Care Coverage

Tuesday, May 01, 2012

Now that the Supreme Court has heard arguments on the Affordable Care Act (otherwise known as Obamacare, or the ACA), and we've got months of waiting before we find out what they're going to do, most of the chatter I've read about the individual mandate has been about how the federal government could react if the individual mandate portion of the ACA is overturned.

But if the mandate is overturned by the Supreme Court, or taken out through legislation, there may be a gap where the states are still required to administer these insurance exchanges, but without the mandate that would keep the costs lower for those buying insurance who are higher risk, by forcing the younger and healthier to buy in, or face a painful fine.

Most observers apparently see this as a downside, foreseeing a situation where we could see 50 states with 50 different responses, but I disagree. Watching 50 states look for ways to tackle this problem sounds like a fantastic idea to me. I'd even prefer this to seeing my own ideas implemented federally.

More liberal states could follow Massachusetts' lead and give the mandate a go, and see if the people of those states think the benefits outweigh the downsides for themselves. Conservative states can go ahead and see how some form of more market based approaches work out. Other states may try a series of options offered by think tanks that stop short of mandating, but have penalties, ranging in severity, for putting off buying in or coming in only when you need to because of medical bills you can't afford out of pocket. I argued for the latter approach several months ago, and would love to see how it shapes up against other approaches, 'in the wild'.

Would more younger and healthier people leave states with mandates because they are being forced into buying something they might not have to elsewhere, or will more of them move to mandate states because they want insurance and it will likely be more affordable there? Repeal the mandate and let the states decide for themselves, and we'll find out.

Will companies move more jobs into states with the mandate, seeking lower insurance rates for their employees and offsetting potentially higher spending with more economic growth in the long run? Or will more jobs move into non-mandate states, or states that penalize without mandating, for regulatory or philosophical reasons?

If people really are confident about their ideas really being the best for the American people, they should be more than happy to see them compete with opposing plans. Enough of all the hot air on the subject, lets put them to the test and see what the people want, after being given the opportunity to see the various options in action, and may the best plan win at the ballot box after they've duked it out 'in the wild' of that marketplace (gladitorial arena?) of ideas people are always talking about.

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