Do conservatives consider ESI a defense against the ‘takers?’

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The most prominent discussion involving the Affordable Care Act and employment has been to what extent the law’s employer mandate will effect part-time employment. But Josh Barro raises some lesser known if equally important possibilities for employment impacts, such as reducing job lock and encouraging earlier retirement.

The former is used to describe when folks decline to seek better jobs largely on the basis of wanting to keep their employer-sponsored health insurance coverage (ESI). If individuals had a more viable path to receiving comparable coverage outside of their job, then post-ACA they might be more likely to leave in favor better employment. The latter would happen more often, essentially, because it would be cheaper for both individuals and firms. Americans who are close to Medicare eligibility will find much more affordable coverage on the individual exchanges relative to the pre-ACA market  and companies will find it easier to drop pre-65 retirement health benefits.

Barro makes a convincing case on this, but less so on what that’ll represent politically:

This is a big deal, and it’s a sleeper issue that animates the left-right fight over Obamacare even though it is rarely discussed in the open. Conservatives concerned that we are turning into a nation of “takers” see employer-provided health care as one of the few remaining forces that keeps Americans working. Liberals don’t just want health coverage for all; they want workers to be able to press their employers for higher wages and better conditions, which they can more easily do if they’re less afraid of losing health insurance if they lose their jobs.

This seems intuitive at first. Yet I’m old enough to remember that then Republican Presidential candidate John McCain proposed health care reform approached ESI in much the same way. He proposed ending the tax-preference for ESI in favor of refundable tax credits to purchase health insurance. Of course that would a have induced employers to stop providing health insurance, and was subsequently quite unpopular. Flash forward to last year and Mitt Romney was approaching health care reform in a similar, if less politically unpopular (and maddeningly vague) fashion — instead of ending the tax preference he called for ending the “tax discrimination” of ESI. Essentially his plan was to give everyone the same tax preference for purchasing health insurance. Health care wonks, including conservatives, almost universally favor decoupling health insurance and employment.

The effects from any of these proposals would result in the same or similar worker empowerment that Barro believes the ACA might provide starting next year. Furthermore, they represent the last decade’s worth of major campaign proposals for health care reform and they both advocated for decoupling employment and insurance. Of course they might prefer the status quo to discouraging ESI through the ACA, but that’s far different than seeing it as a bulwark against ‘takerism’ and “as one of the few remaining forces that keeps Americans working.”

Maybe we’re talking about some future policy attitude shift, or perhaps I’m still idealist enough to think it unlikely that conservatives would fiercely oppose any proposal for separating the two. Granted, this wouldn’t be the first time Republicans have turned on their own ideas for health care reform, so I could be wrong in that regard. One thing to note, though, is that the contemporary conservative policy approach is also directed towards empowering individuals. They just frame it as empowering consumers. Opposing this particular aspect of the ACA’s effects on ESI, not on process but on principle, would also represent a refutation of that ideal.


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