For five years, the government forced me to buy health insurance. But starting January 1, I’m free to take whatever risks I please. And if I get sick, you might pick up the tab.
Last year, Congress passed $1.5 trillion of tax cuts and paid for it by defanging the federal requirement to have health insurance — the “individual mandate.” Healthy young invincibles like me no longer need to pay our fair share for health care. That means higher premiums and fewer choices for you, plus 13 million more uninsured Americans.
We can shield ourselves from the chaos in Washington by embracing what Mitt Romney once called “the ultimate conservative idea.” To wit, Pennsylvania should follow New Jersey’s lead by enacting a personal responsibility requirement to purchase health insurance, because those who can afford to take care of themselves, should.
Pennsylvanians are struggling to pay for health care. Half of the Commonwealth experienced health-care affordability burdens last year, and 4 in 5 worry about affording health care in the future. Despite this, Washington effectively raised our insurance premium by 6 percent this year by repealing the individual mandate. Some counties were hit particularly hard: For example, a 40-year-old woman in Bucks or Montgomery Counties making $30,000 a year will pay an additional $175 every month for insurance. If a personal responsibility requirement had been in place, her premium would have decreased by $70 instead.
Our health-care system only works if lots of healthy people like me make the responsible choice to sign up for insurance. If sick people had to pay the full cost of medical treatment, no one but the richest of the rich could afford care. Instead, both healthy and sick people buy insurance, and the big bills of those who become ill are effectively paid by the premiums of those who were lucky enough to remain well.
But health insurance is expensive, so healthy people like me may decide not to pay into the system, especially now that there’s no penalty for remaining uninsured. With fewer healthy people to subsidize the sick, the nearly 400,000 Pennsylvanians insured through the federal health insurance marketplace will see their premiums rise. Over time, this could cause the marketplace to fail in a “death spiral” of high costs, low enrollment, and insurer exits. A personal responsibility requirement would stabilize Pennsylvania’s health insurance markets and ensure that those who can’t get insurance from their employer or the government have access to affordable health care.
It would also save the Commonwealth more than $400 million every year in uncompensated medical bills. This is because the law guarantees that I’ll be treated if I’m wheeled into the ER after a car crash even if I’m uninsured. More often than not, the willingly uninsured will hitch a free ride on your tax dollars.
Finally, a personal responsibility requirement would protect Pennsylvanians from dangerous “short-term limited duration” and “association” health plans. These skimpy plans attract reasonable people looking for financial relief with premiums as low as $25 a month, but hide gaping holes in coverage that can leave unsuspecting people with massive medical bills. A responsibility requirement would effectively outlaw these pernicious scams, protecting Pennsylvania consumers and preventing sabotage of our health-care marketplace.
Many libertarians have justifiably criticized personal responsibility requirements as an affront to individual liberty. There is some truth to this: Forcing people to buy something requires some restriction of freedom.
But my rights end where yours begin. I should have the freedom to buy and drive a car, and with that freedom comes the responsibility to purchase car insurance, just in case I crash my car into yours and can’t pay for your repairs. My decision to become uninsured is like choosing to rear-end the guy in front of me on the turnpike, because it increases his health-insurance premium, and yours, too. In that sense, it’s just as reasonable to require me to buy health insurance as it is to require me to have car insurance.
The Pennsylvania Republican Party now has a chance to stand up for genuine conservative values, and show the rest of the country what real moral leadership looks like. It is not common that a policy comes along that makes both moral and economic sense. Governor Wolf and his Republican colleagues in the Pennsylvania General Assembly should jump at the opportunity.
Jonathan Fried is pursuing a medical degree at Harvard Medical School and a Master in Public Policy at the Harvard Kennedy School of Government. He is a graduate of the University of Pennsylvania, and previously worked for the federal Centers for Medicare & Medicaid Services.