Documents and Legislation

Don't have health insurance? Don't want to pay for it? Too bad.

It's looking as if President Obama and the Democrat-controlled Congress are going to require you to pick up the bill.

In Washington-speak, it's called an individual mandate — a requirement that people who don't already have health insurance must purchase it, much as most states require drivers to have car insurance.

Obama long has been wary of the idea, arguing that people cannot be required to buy coverage if they can't afford it. His plan during the presidential primary required only children to have coverage. He and then-rival Hillary Clinton, who backed a universal requirement, sparred repeatedly over the issue.

Now Obama has set in motion a health care overhaul, largely leaving the details to Congress.

But in recent weeks, Congress signaled that legislation overhauling health care was all but certain to require that people have insurance.

The president's support for the requirement is recent — and conditional.

In a letter in early June, he told key Senate Democrats he was willing to consider “shared responsibility,” requiring people to have insurance with employers sharing in the cost. “But,” he added, “I believe if we are going to make people responsible for owning health insurance, we must make health care affordable.”

He went a smidgen further last week, saying he is open to “a system where every American bears responsibility for owning health insurance” – provided there is a “hardship waiver for those who still can't afford it.”

Even before the president took office, the insurance industry, which killed former President Clinton's health care overhaul, indicated it was willing to stop denying coverage for pre-existing conditions, making a mandate all the more likely.

Democrats have previously opposed such a mandate, fearing it would disadvantage the poor. In fact, it was Republicans, including 1996 presidential nominee and former Sen. Bob Dole, who pushed the idea in the 1990s.

But support is growing:

♦Insurers like it because it means new customers.

♦Businesses back it, seeking help with providing coverage.

♦Hospitals and doctors are tired of providing services for free.

♦Advocates for the poor are conditionally favorable, if so-called hardship waivers are included.

Even so, some conservative Republicans likely will argue that Obama is stepping on individual rights and creating a pathway to socialized medicine. Last week, congressional conservatives offered their own plan.

But even Republicans say a requirement is likely.

“I believe there is a bipartisan consensus to have individual mandates,” says Iowa Sen. Chuck Grassley, the top Republican on the Senate Finance Committee.

The reason is fairness, he explains, noting that for the uninsured, “there is no free lunch. Somebody else is paying for it.”