Now, as I said, it remains true that the individual mandate is the least popular element of the Affordable Care Act. Part of the conservative fantasy is that Republicans can tug on this one thread and thereby unravel the whole structure of health care reform. The mandate does play an important role in the program. If you require insurers to cover everybody regardless of health conditions, then you have to prevent people from going without insurance and then just signing up when they get sick. If you let people do that, then healthy people will stay out of the pool until they get sick, rates will go up, driving out others, until there’s nobody left but those with serious medical conditions. Eliminating the mandate is therefore the Leninist plan to collapse the system.
But, first, this kind of collapse is something insurers will fight desperately to stop (and insurers still have a lot of clout with Republicans.) Worse, it’s not the kind of result conservatives would desire either. You’d still have a system of private insurance subsidies and increased Medicaid coverage for the indigent along with regulated private insurance. Collapsing the private insurance market might well just push everybody into Medicare or Medicaid. It’s the single-payer health fantasy come to life! (That, of course, is one reason why I think it won’t happen.)