Donald Trump On ObamaCare: ‘I Like the Mandate’

[katzenjammer]

I agree - I heard the interview too, and Trump appeared to favor the ACA's core reform of mandating that insurance companies issue policies without regard to an individual's pre-existing conditions.  This is known as "guaranteed issue".   

The problem, of course, is that insurance companies cannot make money with guaranteed issue without either (i) raising rates to unaffordable levels, or (ii) expanding the insurance pool so there are enough healthy lives to offset the unhealthy lives who can only be insured under guaranteed issue.   That's where the individual mandate is supposed to come in.   On pain of paying a tax,  individuals are encouraged to join the pool.  You hardly need such an incentive if you're sick.   You may very well need such an incentive if you're healthy and either consider yourself bulletproof (like a lot of young folks) or have the means to "self-finance" you health care.   What's killing the ACA is the individual mandate isn't working to get enough healthy lives into the individual insurance marketplace.   Folks rationally decide to pay the tax rather than buy health insurance they can't afford.

And THAT's the big lie of the "Affordable Care Act".   It was never designed to make health insurance more affordable.  It's intent is to expand access.  It's critical flaw is that it stifles competition in the individual marketplace by forcing insurers to provide only gold-plated insurance that covers, among other things,  prescription drugs, mental health treatment, preventive services of all kinds including, notoriously,  contraceptives, maternity care and a host of other services that many folks, if they had the choice, would choose to forego.   But they can't in the ACA marketplace - plans compete not on the host of services covered - they must all be comprehensive, bloated plans - but on the amount of co-pays and deductibles (the so-called bronze, silver, gold and platinum plans).   

It's insane.   Many folks would like the option of getting health insurance for the purpose for which insurance is traditionally intended - to guard against catastrophe.   Not to pay for check-ups and other routine, predictable stuff.  What auto insurance policy covers oil changes?   You pay for that stuff yourself.  But the nanny state refuses to trust individuals to take care of their own health without resort to "free" or almost free routine services.  And that drives up the cost of insurance to unaffordable levels,  so folks have little choice but to pay the tax.

It appears that you have a very keen insight into this overall issue, I look forward to reading more of your thoughts on this topic.

[Jazzhead]

It appears that you have a very keen insight into this overall issue, I look forward to reading more of your thoughts on this topic.

Thanks, Katz.  You know well my opposition to Donald Trump - but on this issue he's not that far off the mark.   

[katzenjammer]

Thanks, Katz.  You know well my opposition to Donald Trump - but on this issue he's not that far off the mark.

I will be very frank with you, Jazz. 

I don't think that any of us know what Trump fully has in mind on this topic (including Trump!).

I will say this, and it isn't limited to this topic alone, what everyone needs to understand is that Trump, Cruz, Kasich, Carson, etc. are primarily engaged with winning a nomination at this point.  Then, whichever one of them succeeds in that, will then be focused on winning the general election.  This is true for everyone of them, perhaps more so for some than others.  That is why I pretty much take everything that all of them say in this mode, with a large grain of salt!

The following is my predication, regarding how Trump (or most any of them) would handle it, if he succeeds at winning the general election.

1.  He will hire subject matter experts to fill advisory roles.

2.  He will engage legislative liaisons that will manage the give and take with the (majority & minority) leaders of both chambers.

3.  At some point, it will be determined how the repeal of ACA will be handled in both chambers (if it will indeed be possible).

4.  Concurrently they will be drafting replacement legislation.  Again, cabinet heads, top staff, subject matter experts, and presidential advisers will all be engaged.  And of course, the non-governmetal interests will all be clamoring for their place at the table.

5.  At some point (perhaps a lot later than many may expect!) the repeal vote and replacement votes will be held.


What will the replacement legislation look like in the end?  I have no clue.  I hope that it will be better than what it replaces.  I hope that it will be as close to a free market-based solution as possible, given the realities of America 2017.  I hope that it includes some of the items that Trump has talked about thus far: opening up health insurance markets across state lines; health care savings accounts (though I really dislike social engineering in the tax code!); cutting out a large part of the fraud and waste endemic in Medicare, Medicaid, CHIPS; negotiating better pricing with providers for the government run programs, etc.


Is it likely to be everything that I would hope for?  Probably not.  Will it be worse than the ACA?  Probably not.

That is why, I am very interested to read the opinion of folks like yourself, that appear to have studied this topic for some time.  Because I am not really sure what indeed is possible and preferable with any replacement legislation.

[Luis Gonzalez]

I have no doubt that Donald Trump wants to open up healthcare to the free-market.

There is no logical way to use the words "mandate" and "free-market" in the same sentence.

[Luis Gonzalez]

This is one of the more disingenuous threads I've seen lately.  Apparently no one actually watched the tape.   I did and also saw this live.  Here is what you missed: 

In answering a specific question about pre-existing conditions:

The mandate Mr. Trump likes is the mandate that pre-existing conditions cannot be excluded from coverage----AND ONLY the mandate that pre-existing conditions cannot be excluded from coverage.

Are we all clear now?

It seems that we are, but you aren't.

There is NO WAY to mandate health care providers to treat the uninsured sick without expectations of payment for services rendered, so someone HAS to pay, and that someone will be the taxpayers by way of the government.

Single-payer health care.

Bernie Sander land.

[kevindavis007]

Not seeing how anyone in TrumpNation can defend what Trump said, or defend the Obamacare Mandate.      But they will try, ohhhh, will they try.

I also think they are the same people who didn't like Romney cause of Romneycare.. 

[Jazzhead]

There is no logical way to use the words "mandate" and "free-market" in the same sentence.

Sure there is.  Look at auto insurance - most states "mandate" that a driver obtain liability insurance in order to drive on public roads.  But most drivers have a fairly wide choice of private insurance options and can choose how much protection they need and want.  Now, sure, the business of insurance has always been subject to state regulation (for example to address such things as insurance reserves).   But in many states a private marketplace can and does exist that provides motorists with real choices.   That's what the ACA fails to do - provide consumers with affordable choices, that take into account the many degrees of tolerance for risk and the one's willingness and ability to self-finance a portion of that risk.   

[Luis Gonzalez]

Sure there is.  Look at auto insurance - most states "mandate" that a driver obtain liability insurance in order to drive on public roads.  But most drivers have a fairly wide choice of private insurance options and can choose how much protection they need and want.  Now, sure, the business of insurance has always been subject to state regulation (for example to address such things as insurance reserves).   But in many states a private marketplace can and does exist that provides motorists with real choices.   That's what the ACA fails to do - provide consumers with affordable choices, that take into account the many degrees of tolerance for risk and the one's willingness and ability to self-finance a portion of that risk.

BUT, you don't have to buy auto insurance if you don't drive, and you don't have to buy auto insurance if your driving is limited to your own property, and (as you said) you don't have to buy auto insurance if you can show that you are financially capable to address the damages you may cause in an accident.

An auto insurance mandate would require everyone to purchase auto insurance, whether they needed to or not, which is what the health care mandate does.

[jmyrlefuller]

Sure there is.  Look at auto insurance - most states "mandate" that a driver obtain liability insurance in order to drive on public roads.  But most drivers have a fairly wide choice of private insurance options and can choose how much protection they need and want.  Now, sure, the business of insurance has always been subject to state regulation (for example to address such things as insurance reserves).   But in many states a private marketplace can and does exist that provides motorists with real choices.   That's what the ACA fails to do - provide consumers with affordable choices, that take into account the many degrees of tolerance for risk and the one's willingness and ability to self-finance a portion of that risk.

But a person can also choose not to drive or own a car and be rid of the mandate altogether. That's not true with the ACA, which mandates one buy insurance or pay a comparable amount to get nothing for merely existing. If I do not use the health care system, or if I pay for a service out of pocket, I still have to pay a penalty under the ACA or buy insurance I won't use, and certainly won't use to the point of making a return on my investment.

Consider: under the ACA, which mandates 80% of an insurance provider's profits go to care, a person of average health would spend 25% MORE on health care through insurance than he or she would out of pocket. That's the mean—not even the median—and if one is even healthier than the average person, that figure is even higher. Consider that a small portion of the sickest people put a disproportionate strain on health care resources, and one soon comes to the conclusion that for the vast majority of people, health insurance is a very expensive scam.

[NavyCanDo]

Sure there is.  Look at auto insurance - most states "mandate" that a driver obtain liability insurance in order to drive on public roads.   

Stop it with the comparing auto insurance with health insurance. Its been a Liberal argument from the beginning, and now we see supposed conservatives using it - all to cover for Trump. Where were you in covering for Romney in the same way because of his states mandate?   
 With car insurance I have the  choice of buying “liability” insurance and opting out of “collision. Young adults who will rarely see a doctor cannot opt out and it would be against the law for them to pay cash, rather than using insurance.   They also cannot buy a smaller coverage plan, or even a catastrophic coverage only plan. 
Car insurance is to cover the other guy, unless you get full coverage which is your choice as long as you own the car.  And if you don't have car insurance, nobody is there to fine you - unless you get pulled over or in an accident. With Obamacare - you have the IRS making sure you do. 

[NavyCanDo]

I also think they are the same people who didn't like Romney cause of Romneycare..

Welcome Back!    TBR is a better place for it.   

[Jazzhead]

But a person can also choose not to drive or own a car and be rid of the mandate altogether. That's not true with the ACA, which mandates one buy insurance or pay a comparable amount to get nothing for merely existing.

It's an unusual tax, to be sure,  but a tax it is.   The key to understanding why is the fact that the mandate is NOT comparable to the cost of the insurance.  It's far less.   For most folks,  the individual mandate will, next year I believe, be a bit less than $700.   You know how much comprehensive health insurance costs - it's in the several thousands.  If the mandate penalty was anything comparable to the cost of the insurance,  I strongly believe it wouldn't have been held Constitutional as a tax.   It would amount to compulsion in the way you describe.    But millions will be rationally paying the penalty rather than endure the expense of purchasing comprehensive health insurance they either feel they can't afford or don't need.   

It's never been held unconstitutional to tax you for something you don't need or believe in.   You've got to pay that portion of your taxes that goes, say, to fund the military or give economic aid to the Palestinians.   

I think the opponents of the mandate could have made a stronger argument before the SCOTUS if they'd focused on the (inevitably, given that it's a Democrat law) progressive aspect of the mandate.   For folks with higher incomes, the mandate penalty is a percentage of income, and can be far higher than $700.   For some of those folks,  there really is compulsion to purchase a commodity or pay a penalty that exceeds the cost of the commodity.   I can't readily think of a precedent for that.   

[Jazzhead]

There is NO WAY to mandate health care providers to treat the uninsured sick without expectations of payment for services rendered, so someone HAS to pay, and that someone will be the taxpayers by way of the government.

Single-payer health care.

Bernie Sander land.

That's one way to do that, but it's not the only way.   The whole point of a conservative idea like RomneyCare is to insure the sickest with affordable private insurance, by creating a large enough insurance pool through enforcement of an individual mandate.  ObamaCare bolloxed the job, but conceptually the individual mandate is a tool for solving the access issue while avoiding single payer.

Keep in mind that there are systemic advantages to encouraging competition in the insurance marketplace.  Insurers can compete with respect to the design and scope of coverage.  Folks can get catastrophic-only coverage if that's all they need.   Insurers can compete in terms of breadth and quality of provider networks.   Physicians have more options about how they practice.   Medical innovation is encouraged,  because some insurance products will cover more experimental therapies. 

 The basic fix I'd prescribe is to keep the mandate but open up competition in the marketplace.   And fix the employer mandate (a subject for another day),  so employers are incentivized to send their employees with dollars to the competitive individual insurance marketplace,  thereby salting the pool with more younger and healthier lives - and driving costs down. 

[Jazzhead]

Stop it with the comparing auto insurance with health insurance. Its been a Liberal argument from the beginning, and now we see supposed conservatives using it - all to cover for Trump.   

C'mon,  NCD,  you know perfectly well I cannot abide Donald Trump!

I'm not saying health and auto insurance are the same thing.   But the insurance regime for autos is instructive when pondering what to do about the access issue for health insurance,  and more importantly, what not to do.   It's not "liberal" to examine different insurance regimes and attempt to draw lessons, find parallels, and recognize differences.   That's due diligence, that's academic inquiry.

I assume you're opposed to single payer.  So am I.   But I want to address the access issue,  and recognize that an individual mandate is an essential tool in doing so in the context of a competitive, market-based system.   

[musiclady]

I also think they are the same people who didn't like Romney cause of Romneycare..

GOOD to see you, kevin!  I agree with Navy - this is a better place when you're here!   

[NavyCanDo]

C'mon,  NCD,  you know perfectly well I cannot abide Donald Trump!

I'm not saying health and auto insurance are the same thing.   But the insurance regime for autos is instructive when pondering what to do about the access issue for health insurance,  and more importantly, what not to do.   It's not "liberal" to examine different insurance regimes and attempt to draw lessons, find parallels, and recognize differences.   That's due diligence, that's academic inquiry.

I assume you're opposed to single payer.  So am I.   But I want to address the access issue,  and recognize that an individual mandate is an essential tool in doing so in the context of a competitive, market-based system.   

Every republican candidate has in their platform to repeal and replace Obamacare, not to go back to the way it was. But if there is going to be a law that you must have some sort of coverage, then let there be different levels of coverage, based on the persons age and or needs. And allow them far more options for shopping for the plan that best fits them, including "no plan", which would instead be a health savings account you keep growing in case you need it.

 Let the plans advertise for your business, just as car insurance companies do. We need FLO selling medical insurance. Forget that, make that the Amica girls selling medical insurance.   
Choices now are very limited, and the mandate, and the "choose today on a web site that keeps crashing, or pay a stiff fine tomorrow" is very very intimidating. The stress level each year is far more than doing taxes they say.    Thankfully my employer covers mine.

[Jazzhead]

Every republican candidate has in their platform to repeal and replace Obamacare, not to go back to the way it was. But if there is going to be a law that you must have some sort of coverage, then let there be different levels of coverage, based on the persons age and or needs. And allow them far more options for shopping for the plan that best fits them, including "no plan", which would instead be a health savings account you keep growing in case you need it.

 Let the plans advertise for your business, just as car insurance companies do. We need FLO selling medical insurance. Forget that, make that the Amica girls selling medical insurance.   
Choices now are very limited, and the mandate, and the "choose today on a web site that keeps crashing, or pay a stiff fine tomorrow" is very very intimidating. The stress level each year is far more than doing taxes they say.    Thankfully my employer covers mine.

Agreed on all counts, NCD!

[HAPPY2BME]

Donald Trump said Sunday he actually opposes Obamacare's individual mandate, following up his reversal last week of his apparent support for the law.

"We were talking over each other," Trump said of his conversation with Cooper. "But what I'm talking about is very simple. There's no mandatory anything. We're going to end Obamacare and it's going to be repealed."

http://www.washingtonexaminer.com/donald-trump-ditches-defense-of-obamacares-individual-mandate/article/2583809

[DCPatriot]

That quote is what he should have said from the beginning.

First repeal/revoke....then let the free market work across state lines for people shopping for healthcare.

The ones that can't afford it?  Set up low-costs plans through Medicaid...but under no circumstances should it be free of charge.

[Formerly Once-Ler]

Walking back Trump.

[sinkspur]

http://www.weeklystandard.com/trump-i-like-obamacares-individual-mandate/article/2001172/?utm_medium=social&utm_source=t.co&utm_campaign=20160219_TWS-blog-trump-mandate-2_twitter&utm_content=TWS

Trump: I 'Like' Obamacare's Individual Mandate

7:48 AM, FEB 19, 2016 | By JEFFREY H. ANDERSON
 
The most unpopular part of Obamacare now has a champion in the Republican presidential field. Via the Right Scoop, Donald Trump was asked on Thursday night by CNN's Anderson Cooper, "If…there's no mandate for everybody to have insurance, what's to—why would an insurance company not have a preexisting—insure somebody with a preexisting condition?" Trump replied, "Well, I like the mandate. Okay, so here's where I'm a little bit different. I don't want people dying on the streets. And I say this all the time."

Well, that's certainly "a little bit different"—in fact, it's hard to get a lot more "different" than to run for president as a Republican and support the hated cornerstone of President Obama's signature legislation. This "mandate for everybody to have insurance" is, of course, the unprecedented requirement that, for the first time in the more than 200 years of United States history, private American citizens must buy a product or service of the federal government's choosing merely as a condition of living in their own country.

To the best of my knowledge, not since Mitt Romney has a prominent Republican officeholder or top-tier candidate for office expressed fondness for the individual mandate.


But Trump went further even than that. He implied that those who oppose Obamacare's liberty-sapping mandate do "want people dying in the streets."

With the exception of Jeb Bush, no current Republican presidential candidate has yet advanced an Obamacare alternative. As a result, the GOP candidates have failed to elevate the most important domestic issue of the Obama presidency or demonstrate that they know how to lead the way to full repeal. But at least they don't support Obamacare's coercive core.

Indeed, Obamacare's individual mandate is not only coercive but unconstitutional. Obama's congressional allies claimed that passing it was a valid exercise of their authority to regulate interstate commerce, but the mandate was rejected as unconstitutional on those grounds by the Supreme Court—with Justice Scalia in the majority on this question—because in truth it was an effort to compel commerce, not regulate it. The mandate was rescued only because five of the Court's nine justices decided that it could plausibly be reinterpreted as a constitutionally permissible "tax"—even though Obama had insisted all along that it wasn't a tax, and even though the legislative text declares it to be an "individual responsibility requirement" paired with a "penalty" for noncompliance.

Imagine, if you would, a health care debate between Hillary Clinton and Donald Trump

[Formerly Once-Ler]

He already walked this back this morning...but give him time.  In a few days he will walk back his walk back and be for it again.  Trump is a floor wax and a desert topping.