Obama Scraps Health Mandate for Some -- But Why Not All?

The Obama Administration announced Friday that it would scrap the individual mandate to purchase health care insurance for people with policies that were canceled, putting a major crack in the president’s signature legislative achievement.

Though Obama's decision represents an admission of defeat, it also represents a chance for Democrats to regroup and ultimately win the discussion by going in a completely new direction.

Under the revised plan, people who had insurance through the individual marketplace will be allowed to buy cut-rate “catastrophic” policies that do not provide the law’s minimum standard of care, provided they qualify for a “hardship exemption.”

“The premiums for these plans, which are otherwise only available to individuals under 30 years of age, are on average about 20 percent lower than premiums for other plans available in the marketplace,” Health and Human Services Secretary Kathleen Sebelius explained in a letter (PDF) sent to Senator Mark Warner, of Virginia, this week.

The new exception follows President Obama’s decision to let cut-rate insurance policies continue to be sold for another year, as a response to the fallout from insurers purging their rolls of higher-risk customers and pushing them off into the state and federal health care exchanges.

Both decisions came as a result of Republican criticism of Obama’s now-notorious pledge that if Americans liked their health policies, they could keep them. Even so, Obama pledged in November to reject any proposal that would “undermine or repeal the overall law and drag us back into a broken system.”

Since a key pillar of the law is its mandate that everyone purchase health insurance, it would seem he’s gone back on that as well. Still, Sebelius insisted to Warner that the exception to the mandate is “temporary,” meant to ease the transition.

Republicans, however, are sure to pounce on the move. It's a clear shift in momentum after years of failed attempts to dismember or kill the law. They are now poised to rip even more limbs off the Affordable Care Act and deny health coverage to millions more Americans.

But it doesn’t have to be this way.

Obama could, instead, pivot left and have his allies in Congress reintroduce the public option -- that seemingly forgotten bit of the Affordable Care Act that was replaced during the legislative process by a Republican proposal for the individual mandate.

We already know this is a winning issue, too. A CBS/New York Times poll (PDF) taken in September 2009, when the health reform debate was firing on all cylinders in Congress, found that 65 percent of Americans support public health care, including a plurality of Republicans.

Think about it: By making public health care a centerpiece of their 2014 electoral push, Democrats could campaign against Republican governors who are standing firm against taking care of their poorest citizens. Indeed, a public option could bypass them completely, bringing a necessary benefit to millions who would otherwise be deprived. A public option would also introduce something that’s sorely lacking from this whole health care reform experience: simplicity.

Republicans will do everything they can over the next year to ensure that “Obamacare” remains below water in the polls, fighting every inch of the way to block its implementation and make what does get off the ground seem immensely complicated and not worth the public’s time. Democrats should combat this strategy by completely flipping the script and making sure every American has access to health care.
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