Mandated coverage imperils health bill

A proposed requirement that all Americans carry health insurance has been met with skepticism by both Republicans and Democrats who, as the bills head to the House and Senate floor, are worried about its impact.

Conservatives say that the cost of purchasing coverage would amount to a new tax on Americans, particularly those making less than $250,000, violating a campaign pledge by President Obama. Democrats are leery of passing the mandate without enough tax subsidies for low- and middle-class Americans to help them obtain coverage.

“It’s a push and a pull,” said Sen. Charles E. Schumer, the New York Democrat who successfully proposed amendments in the Senate Finance Committee to allow more low-income people to get out of the requirement. “You want to cover as many people but you can’t make it unaffordable to people. It’s going to have to be a balance.”

All of the health care reform proposals working their way through Capitol Hill include the so-called “individual mandate,” making it likely to be in any bill that lands on the president’s desk.

The reform debate is expected to speed up as soon as the Congressional Budget Office releases its cost estimate of the Senate Finance Committee’s bill, which could come as soon as Wednesday. Democrats, meanwhile, hope to use recent pledges of support from prominent Republicans as a sign that Republicans on Capitol Hill, who largely oppose the reform plans, are out of touch.

On Tuesday, California Gov. Arnold Schwarzenegger voiced support for the president’s reform plan, but stopped short of endorsing it.

“Our principal goals, slowing the growth in costs, enhancing the quality of care delivered, improving the lives of individuals, and helping to ensure a strong economic recovery, are the same goals that the president is trying to achieve,” the Republican governor said.

The statement comes after endorsements of the Democrats’ plan Monday by Tommy G. Thompson, Health and Human Services secretary under President George W. Bush, and by New York Mayor Michael R. Bloomberg, an independent.

As the bills move to the House and Senate floor for what’s expected to be lengthy debate, Republicans will argue that the insurance mandate is merely a new tax and isn’t necessary.

“It’s a violation of people’s freedom that want to self-insure or maybe just don’t want to buy health insurance or maybe can’t afford it,” Sen. Charles E. Grassley of Iowa, the top Republican on the Finance Committee, has said.

Moderate Democrats, such as Sen. Ben Nelson of Nebraska, aren’t keen on the idea of a mandate, either, but they understand the goal.

“I have a problem mandating it, but I also have a pretty clear understanding that if you don’t get virtually everybody into the plan, then the law of large numbers … won’t work,” Mr. Nelson said. “Then you’ll be raising premiums for people who are already in a plan to take care of those who are sick.”

Proponents of the insurance requirement say it would help ensure that all Americans get coverage, reducing the additional costs insured people pay to cover the uninsured. All of the proposals have subsidies for the poor and exemptions for the extremely poor.

The Senate plan would impose a fine of $750 in additional taxes on individuals who refuse to obtain coverage. If the cheapest insurance coverage would surpass 8 percent of a person’s income, he or she would be exempt.

The House plan would impose a fine of 2.5 percent of an individual’s income.

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