Ezra Klein, now at his new web address at The Washington Post, tags off the report by The New Republic’s Jonathan Cohn that health reform might not cost as much as believed. The Congressional Budget Office is projecting that some portion of the uninsured will stay uninsured, even with the “individual mandate.”
But this should not be a surprise. We have an “individual mandate” for drivers to have auto insurance, and yet have a noncompliance rate of around 15%–although it ranges depending on the state. For the most part, the issue isn’t enforcement: my assumption–confirmed by survey research–is that the vast majority of people want health coverage-desperately; the question is will the reform remove the barriers and provide the assistance needed? Will the reform make coverage more available and affordable? Will it be easy to enroll–or even automatic?
So what the reform includes matters a lot in terms of how “universal” it is. Provided that affordability is assured, I don’t think the mandate is as important as an automatic-enrollment mechanism, as with Medicare or on-the-job benefits.
These kinds of structural issues matter, I think, even more than Ezra’s initial take that some of the remaining uninsured will be undocumented immigrants. According to UCLA research, undocumented are a small fraction–about one-fifth–of the uninsured. Around 75% of them are workers or family members of workers, more of whom may–and should–get coverage from their employer under a reformed health system. At the very least, we can all agree that if you work and pay your dues, you should get coverage. And Ezra points out why that’s important, regardless of where you are in the immigration debate. But health reform is a much broader issue that affects everyone, insured and uninsured.
Our job as consumer advocates and organizers is to push for the policies to make coverage more available and affordable for all, and for the financing to make that a reality.