More on Butler and the individual mandate

Kenneth Thomas has a nice post on Stuart Butler’s change of heart on the individual mandate. I think he and Aaron think I was too easy on Butler, and Ezra Klein likely concurs, especially given the timing of Butler’s switch.

One point from Butler’s USA Today piece that I want to highlight and comment on:

So why the change in this position in the past 20 years?

First, health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage. For example, the new field of behavioral economics taught me that default auto-enrollment in employer or non-employer insurance plans can lead many people to buy coverage without a requirement. [emphasis mine]

The thing I most hold against Butler and many other conservatives is the degree and vociferousness of their opposition to the ACA given their past positions. A reasonable, policy based opposition might have gone something like “I used to support the individual mandate, but no longer think it is the best approach. Instead of an individual mandate, we should use auto-enroll procedures to attain the needed risk pooling. The CBO should estimate how different the individual mandate is from aggressive auto enroll procedures.”

Instead, the individual mandate was painted as an unimaginable affront to the Republic, etc. etc. and this had the effect of moving us away from the policy.

Interestingly, the first comprehensive reform bill introduced into the 111th Congress (on May 20, 2009, about a month before the first version of HR 3200 was reported out of any House committee) was the Republican sponsored Patients’ Choice Act (PCA), that had at its heart the use of auto-enroll procedures to achieve risk pooling.

It was introduced by Reps. Paul Ryan and Devin Nunes, and Sens. Tom Coburn and Richard Burr. This plan proposed altering the tax treatment of employer paid insurance, providing individuals with money to defray the cost of buying private insurance in state based exchanges, and advocated auto-enroll procedures such as signing persons up by default when they renewed their drivers license or paid state income taxes. There are some big problems with this bill, however, there are similarities with the ACA that suggest that a deal could be possible in policy terms.

The PCA has never been scored by CBO. I have written that I would like to know how different auto enroll procedures would be from the weak individual mandate contained in the ACA, in terms of insurance expansions.

Given that Stuart Butler has included his interest in auto-enroll procedures as a reason for no longer supporting an individual mandate, I would love for him to join me in calling for the sponsors of the Patients’ Choice Act (one of them is my senior Senator) to provide the details necessary for the CBO to score their bill. This would provide us with some sense of the relative effect of auto enroll procedures vs. an individual mandate in expanding insurance coverage. Who knows, we might accidentally stumble upon a compromise.


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