The legal mandate is gone. But let’s not fret. It is now essential the Democratic Party and progressives everywhere rally around the ACA and transform the legal mandate in 2017 to a “Moral Mandate” in 2018. Until Medicare for All becomes a reality, progressives should make registering for health care as core to our beings as registering to vote, ensuring the vitality of the ACA in 2019.
A rallying cry, a badge of honor and signing up 25 million people for 2019 should be a goal of the Democratic Party.
Rumors of the ACA’s imminent death have been part and parcel of the misinformation campaign by Republicans for years now. When Rachel Maddow, Democrats and progressives suggest the tax bill of 2017 has “gutted” the Affordable Care Act by eliminating the mandate, not only are they dead wrong, they are playing right into Republicans’ strategy.
In 2018, the ACA will serve over 20 million people, despite a shortened sign-up period, no advertising support and relentless attempts by Trump and Republicans to scuttle the law. Not only are there tens of millions of Americans who don’t need a mandate to participate, if young and healthy citizens embrace participation as part of their social contract—keeping costs low today, so when they are old costs are low for them—the ACA can thrive.
Here are five reasons a moral mandate and 25 million sign-ups in 2019 should be our number-one issue.
1. The ACA Is Alive and Kicking
According to Obamacare Facts, there are now 20 million-plus “currently covered between all coverage provisions (that is between the Marketplace’s 10.3 million, Medicaid expansion’s 11 million or so, about 2.6 million young adults staying on their parents' plan, the many newly covered via the employer mandate, and those covered under other coverage provisions created by the ACA).”
According to Gallup, "Fifty-six percent of Americans say the federal government should be responsible for making sure all Americans have healthcare coverage, up slightly from 52% last year and the highest level in 10 years.”
2. The Legal Mandate May Be Overblown
Don’t listen to me; listen to Larry Levitt, senior vice president of the Kaiser Family Foundation. According to the Washington Post, “at a time when the most recent polls show that slightly more than half the public regards the ACA favorably, removing the most objectionable feature 'could even be a blessing in disguise' for supporters.”
3. We Can Create a Moral Mandate for Young People to Vote and Register for Health Care
According to CNN, “ending the penalties will cause an additional 4 million people to be uninsured in 2019 and 13 million within a decade, according to the nonpartisan Congressional Budget Office. Insurance premiums in the ACA marketplaces will rise an extra 10 percent in most of those years, the CBO estimates.”
But this simply does not have to happen.
To make registration a rallying cry, to make the participation of young people in the markets a moral mandate, will ensure the predicted reductions do not take place. Approximately 4 million Americans turn 18 each year, and while most will be on family plans, if insurers see young and healthy people 18 to 34 securing plans, prices and markets will remain stable.
If you are a young Bernie Sanders supporter, but don’t have health insurance, you are no progressive to me. If you join the Women’s March, but don’t have health insurance, you are no friend of mine. If you are registered to vote, but not registered for health insurance, we need to make sure you are in line when registration opens for 2019 come this October 2018.
4. Low-Hanging Fruit: Americans Who Don’t Know They Could Have Health Insurance for Free
To achieve a stable marketplace, according to the Kaiser Family Foundation, the insurance age mix should mimic the general population mix whereby “40% of the potential market is represented by adults age 18-34.” If the moral mandate goal becomes 5 million additional members in 2019 – approximately 2 million would be young people age 18 – 34.
Finding another 3 million Americans should not be hard, considering there are millions of citizens who, if someone sat them down to fill out the forms, could secure a bronze plan for free. It is hard to believe, but it’s true.
A Kaiser Family Foundation analysis found, “that more than half (54% or 5.9 million) of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage. Within that 5.8 million, about 4.5 million (42% of the total) could obtain a bronze-level plan at no cost in 2018, after taking income-related premium tax credits into account, the analysis finds.”
So, the Democratic Party could make it part of its 2019 mission, assigning every county committee nationwide a quota, to find and sign up 3 of those 4.5 million people who can have insurance for free.
5. The Affordable Care Act Protects ALL Americans, Not Just Those With ACA Plans
It took Republican attempts to destroy it for Americans to wake up to the value of the ACA. But even today, many Americans still have no idea the ACA protects every American, whether they have coverage from their employer or through an exchange.
Health coverage rules created by the ACA are now often taken for granted: no rejection for pre-existing conditions, no annual caps or lifetime caps on coverage, and the absolutely, critical 10 Essential Benefits, which require all plans to cover maternity, substance abuse and other ailments that were often excluded from pre-ACA skinny plans. All exist as a result of the ACA for every plan in the nation.
It’s Time to Prioritize and Focus for 2018
The tweeting and assaults on our democracy come hard and fast. And while progressives successfully protected the ACA in June, with a little help from John McCain, the energy level was not the same for the tax bill fight and the clever insertion of mandate repeal. It could be argued no level of resistance was going to stop the Republican Party from controlling all three branches of government from passing a tax bill, but progressives and the Democratic Party will have to pick and choose our battles going forward.
Recapturing Congress and everything that entails—voter registration, candidate identification, fundraising, platform framing, get-out-the-vote—would be at the top of any list and certainly stem the bleeding.
But second on my list would be protecting the ACA. And with the mandate now gone, to change the narrative and counterintuitively commit to growing ACA membership in 2019. It will require a moral mandate and a dedicated focus by the Democratic Party. It will require Rachel Maddow and the progressive movement to boldly defend the ACA today, while fighting for Medicare for All in the future. It will require us to frame the value of full-coverage as the true “freedom” and to establish a new moral mandate to have insurance as part of our social contract and what it means to be a progressive Democrat in 2018.