Obamacare’s mandate didn’t work and wasn’t needed, yet Joe Biden wants to bring it back

Joe Biden, as part of his campaign to revive the Obama years and be the anti-President Trump, has repeatedly vowed to bring back one of the least popular policies of the prior administration: the individual mandate.

The requirement forcing individuals to purchase health insurance under the threat of a penalty was already the subject of one high-stakes Supreme Court case. It is about to be at the center of another. But in practice, it has proven to be completely ineffective.

When Obamacare was first being debated, most healthcare experts believed it was necessary to include a requirement to purchase insurance, so as to corral young and healthy individuals into the insurance market and offset the cost of forcing insurers to cover those with preexisting conditions. Absent the mandate, the logic went, only sick people would purchase insurance, and insurers would find it impossible to continue operating, leading to a so-called death spiral of insurers leaving the market.

Though Barack Obama himself famously opposed the mandate in his 2008 campaign, he flip-flopped under pressure from healthcare experts, the insurance lobby, and the Congressional Budget Office, which warned that the price tag of any healthcare legislation would be much higher without the mandate.

The CBO’s belief in the importance of the mandate has also had dramatic policy implications during the Trump administration. It effectively tanked the effort to repeal Obamacare because all Republican plans called for the elimination of the mandate, which the CBO predicted would alone lead to 13 million people losing coverage. Projections of massive coverage losses gave pause to centrist Republicans and doomed the repeal effort.

It turns out, however, that the mandate did very little. Although lived experience has shown this to be true for years, forcing even the CBO to change its tune, this fact was further confirmed with a new report from the Census Bureau, which conducts the most widely cited survey on health insurance coverage in the United States.

What the Census data shows is that in 2019, which is the first year without the mandate’s penalties in effect, 92% of people had health insurance for at least part of the year — compared to 91.5% in 2018, the last year with the mandate in place. In other words, insurance coverage went up slightly despite the elimination of the mandate.

Democrats have spent the Trump years warning that any attempt to provide consumers with more choices was an attempt at “sabotage.” But the 2019 insured rate was also higher than in 2016, the last full year of the Obama presidency, when it was at 90.9%.

There are multiple possible explanations for why the mandate was not very effective in getting younger people to sign up for Obamacare. One possibility is that the penalties were not strongly enforced or severe enough. Another possibility is simply that Obamacare primarily expanded insurance by providing free or near-free coverage and that it was less attractive to those whose incomes weren’t low enough to have most of their premiums subsidized. But fundamentally, young people have not purchased Obamacare in the hoped-for numbers because it is a rotten deal for them. Effectively, the government decided to offload the cost of covering preexisting conditions on the young by jacking up premiums. Given their scant use of medical resources, younger people logically concluded that they’d rather save their money.

What’s more perplexing is why, given its unpopularity and the growing body of evidence that it’s ineffective, Biden has insisted that he would bring back the individual mandate as president. It could be the liberal obsession with exerting control over individual decisions. But it may be more revealing of the lazy approach that Biden has taken to policy. Essentially, he wants to prove that he’ll do the opposite of Trump on everything, no matter how ineffectual or irrelevant to real-world conditions.

This explains, for instance, how in response to criticism that Trump was being too lax about masks, Biden decided to declare that he was for a national mask mandate — to the point of highlighting it in his acceptance speech at the Democratic convention. Only weeks later did he backtrack and acknowledge that such a mandate would be unconstitutional.

As somebody who keeps talking about how as president he’ll trust science and data, Biden may want to give the latest Census report a gander and rethink his support for reviving the mandate.