As health reform negotiations go on, I continue to be puzzled why the Governor has yet to publicly budge on having some–*any*–affordability standard for individuals in the context of a mandate. Any other politician, concerned about voter reaction, would not just include affordability in their plan, but lead with it. The presidential Democratic candidates, like Clinton, Obama, and Edwards, both provide assurances to voters than coverage will be affordable, both in terms of costs (tied to a percentage of their income), or in terms of benefits (for example, saying that people should have access to coverage as good as what Congress gets).
Some, like health care blogger Alan Katz, have criticized the notion of an affordability exemption–saying it undermines the point of a mandate. The Governor’s team asks, “don’t you want universal coverage?” Of course, but I think they misunderstand the point.
Our goal is not an exemption. Our goal is to get people covered. The affordability standard is a challenge, to insurers to keep costs down, and to policymakers to provide the subsidies needed to low- and moderate-income Californians.
If we have the cost containment and appropriate subsidies in place, then any mandate–even with an affordability standard–would be universally applied, and everybody would have affordable coverage. We’ve reached the goal. However, if the costs continue to rise or subsidies are not there, then let’s not have an unlimited legal requirement placed solely on individual consumer’s shoulders.
There is a conversation to be had about what is affordable, with regards to premiums, out-of-pocket costs, and benefits, but it amazing to me that we are still talking about whether an affordability standard should even exist in the first place.