The mandate must stay

Having failed to “repeal and replace” Obamacare, President Donald Trump and House Republicans are back to trying to dismantle the Democratic-passed health-care law a piece at a time.

Trump already had cut back on marketing efforts to get people to sign up for the insurance, reduced the time period for enrollment and threatened to end one of the subsidies that keeps the cost lower than it would otherwise be.

Now, with the president’s encouragement, congressional Republicans hope to further eviscerate Obamacare by removing the mandate that requires economically able Americans to purchase insurance or pay a penalty.

Having been unsuccessful earlier this year with a straightforward approach to killing the insurance mandate, they’re now trying a backdoor way to get it done — tying it to an equally misguided tax-cut plan that will drive up deficits and mostly reward the rich, including saving Trump and his heirs at least hundreds of millions of dollars.

Republicans hope to pay for some of the tax cut by dropping the insurance mandate, which will in turn prompt an even larger percentage of healthy, younger Americans to drop their coverage and thus reduce government subsidies. The Congressional Budget Office estimates that without the mandate, the number of uninsured will rise by 13 million by 2027 and some $338 billion will be saved in subsidies over that decadelong span.

But here’s the rub.

By making it easy for those with few claims to go without insurance, it will drive up the cost for those who are sicker and older. Plus, it will further encourage insurers to get out of the health market, unless one of the most popular Obamacare reforms is also repealed — automatic coverage for pre-existing conditions. Without the insurance mandate, people could just wait until they are sick to sign up for coverage. Even if they had to pay higher premiums for after-the-fact-enrollment, the actuarial calculations on this would be such a mess that some insurers would say that selling individual policies is not a business they care to be in.

As the number of insured drops, the cost of uncompensated care provided by hospitals would rise. More uncompensated care means either higher costs for everyone else or more hospital closures, especially in rural areas.

This GOP endeavor to tie insurance rollbacks to tax cuts is a plan designed to help the healthy and wealthy. For a poor, rural and unhealthy state such as Mississippi, though, it won’t be wise.

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