A Mandate for Health‐​Care Disaster in D.C.

April 20, 2008 • Commentary
This article appeared in the Washington Post on April 20, 2008.

As goes Massachusetts, so goes the District?

This month marks the second anniversary of the passage of Massachusetts’s landmark universal health‐​care law. As if to mark the moment, the D.C. Council is about to take up legislation to impose a similar plan. Bad idea.

Like Mitt Romney’s plan in Massachusetts, the heart of the District’s legislation, sponsored by D.C. Council member David A. Catania (I‐​At Large), is an individual mandate — a requirement that every city resident buy health insurance. But the bill would affect more than the uninsured. Residents who already have health coverage and are completely satisfied with it — but who do not have the kinds of coverage that the legislation stipulates — would have to change their plans when they come up for renewal. Catania’s bill is silent on what that means, but if Massachusetts is any indication, it will end up costing people money. Worse, it wouldn’t provide the universal coverage Catania promises.

Before Massachusetts enacted its mandate, it had a little more than 600,000 uninsured residents. Under the new program, about 219,000 previously uninsured residents have signed up for insurance, but nearly all of them receive subsidized coverage. Another 70,000 have been signed up for Medicaid. But fewer than 30,000 unsubsidized residents have signed up as a result of the mandate. Despite the mandate, as many as 300,000 Massachusetts residents remain uninsured.

And while failing to achieve universal coverage, the Massachusetts plan cost taxpayers a great deal. It is now expected to exceed its budget by $150 million to $400 million over the next year, and $2 billion to $4 billion more than was budgeted over the coming decade.

What in this track record recommends itself to the District?

If we want only to increase the number of city residents with health insurance, we might start by changing the regulations that make it so expensive. The District currently has 18 mandated benefits, ranging from alcoholism and drug abuse treatment to hormone replacement therapy. These mandates add significantly to the cost of insurance.

Giving customers the choice of whether to buy such coverage would be one of the easiest and most effective ways to reduce the cost of health insurance. That would induce more people to buy it. Or the District could allow city residents to purchase less expensive policies outside the District. Why is that illegal, anyway?

Insurance should be inexpensive for the young and healthy, but the policies Catania recommends, such as guaranteed issue and community rating, make it expensive. The result, in states with such policies — such as New York and New Jersey, as well as Massachusetts — has been disastrous, leading young and healthy people to flee the insurance market in droves.

It’s easy to understand David Catania’s frustration. Health‐​care costs are rising rapidly, raising the strain on family budgets at a time of economic insecurity. Nearly 13 percent of District residents are uninsured, and Congress is stuck in political gridlock. But copying a policy that’s already failing elsewhere is not the answer.

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