The chairman of the House Budget Committee — and author of the GOP’s controversial budget — predicted Thursday that the Supreme Court would nix the individual insurance mandate in President Obama’s health care law. But though he outlined alternative means by which to assure universal health care coverage that he supports, he said the GOP would use the Court’s action to force a fight over dismantling Obamacare.
“I think [the Supreme Court] will knock down the mandate,” Rep. Paul Ryan (R-WI) predicted at The Atlantic‘s annual Ideas Forum. “The question is of sever ability. Will they sever or will the whole thing go down?”
Assuming the Supreme Court goes no further than the 11th Circuit court of appeals, and only tosses the mandate, that will give Republicans in Congress a choice: They can work with Democrats to replace the mandate with something more palatable — but that will assure near-universal coverage, and won’t risk an “adverse selection” problem where healthy people eschew entering the insurance market. Or they can use the mandate’s demise as a leverage moment: let the law fail unless Democrats agree to replace it with a GOP friendlier policy.
Ryan said we can expect the latter.
“Save the President’s health care law? No I don’t think we’ll be in the position of doing that,” Ryan said.
This isn’t a new strategy, as I reported several months ago. The irony is Ryan had just finished explaining that Republicans support a method of building a universal health care system with a twist on the mandate — a policy called “auto enrollment.”
“We don’t think a mandate’s the right idea and obviously we don’t think that it’s constitutional,” Ryan said. “I think auto-enrollment is the answer to this.”
Automatic enrollment can work in a few ways, but typically it allows people to enter a market voluntarily, or else enrolls them automatically after the open-enrollment period — at the DMV, for instance — with an option to opt out. Whether this works as effectively as an individual mandate depends on the details of both — so its effectiveness is an open question. But Republicans won’t have this simple technocratic debate if the Supreme Court strikes the mandate. They’ll hold the crippled health care bill hostage.
