The Affordable Care Act's individual mandate, Republicans keep telling us, is the greatest threat to individual freedom in the history of humankind. But we can't forget that the mandate is a means, not an end. Getting coverage for the uninsured is an end. Bringing costs under control is an end. The mandate is a means of getting (nearly) everyone in the system, so we can do things like make it illegal for insurance companies to deny coverage based on pre-existing conditions. So there's no reason why the mandate couldn't be replaced with something else that accomplishes the same goal.
Rep. Peter DeFazio has introduced a bill to do just that:
Under my proposal, anyone required to purchase health insurance and who does not already qualify for an exemption (current law contains religious and low income exemptions) can opt-out of the mandate.To do so they must file an "affidavit of personal responsibility" with the state exchange. Such a filing will waive their rights to:
1) Enroll in a health insurance exchange;
2) Enroll in Medicaid if otherwise made eligible; and
3) Discharge health care related debt under Chapter 7 bankruptcy law.
These rights would be restored after the person purchases the minimum level of insurance for at least 5 years without subsides or the benefits of the exchange. This will prevent adverse selection, the ability to buy insurance only when you need it.
DeFazio's bill does basically what TAP's own Paul Starr proposed some time ago. Not only does this solve the problem of the the mandate's vicious bludgeon to the nose of liberty, what it asks people to give up if they want to go without insurance is a bunch of other government (ptew!) benefits. So any freedom-lover who hates the ACA should be on board, right? Jon Chait predicts that the response from Republicans will be dead silence. I'll go a step further: If this gains any momentum, Republicans will find a reason to say it's just as bad, or maybe even worse, than the individual mandate. If it ever comes to a vote, every last Republican in the House will vote against it, and every last Republican in the Senate will join a filibuster to prevent it from coming to a vote in the upper chamber. Just you watch.