A renewed Johnny Isakson on health care’s ‘individual mandate’

We were 15 minutes into our lunchtime discussion when Johnny Isakson got to the crux of what Senate Republicans face this week when they renew their attempt to repeal the Affordable Care Act.

“You have do away with the individual mandate, and then define what the new individual mandate is,” Georgia’s senior senator said.

Put another way: With or without Obamacare, somebody will be telling you and me that we need to purchase health insurance, and that somebody must have the ability to punish us — in the wallet — if we do not.

That’s the price of preserving the ability of those with pre-existing conditions to sign up for health insurance. And that’s a feature of the ACA that Senate Republicans aren’t going ditch. “Getting rid of it ain’t going to happen,” Isakson said.

So come what may, healthier people will be required to bear their share.

The only question is whether the enforcing hammer should be wielded by the Internal Revenue Service, as is currently called for under Obamacare. Or by the private insurance company setting the premium, which would be preferable to Isakson and some – though not all – of his GOP colleagues.

“We’ve got to make sure we have everybody in the system and paying. That’s the biggest hitch,” Isakson said. “We would have had a deal two weeks ago if [Senate leadership], the insurance industry and the administration could figure out that one problem.”

The House version, passed in May, would have allowed insurance companies to slap a one-year, 30 percent premium penalty on those who let their insurance lapse more than 63 days. The second iteration of a Senate bill called for a six-month wait on any claims made by those who let their insurance lapse 63 days.

But Isakson said the shape of the Republican hammer remains ephemeral. “There is no health care bill. It doesn’t exist yet,” he said.

And so the hammer doesn’t, either. “It needs to be big enough to make me say, ‘Now, wait a minute, I better keep my insurance, keep that cash flow going,’” Isakson said.

My meeting with Isakson was about health care, obviously. But it also was an opportunity for the senator to demonstrate that he’s back in the game after a rough six months.

Isakson’s tussle with Parkinson’s disease has been public since 2015. But earlier this year, two back surgeries in less than a month had put him in a wheelchair.

Intense physical therapy allowed the 72-year-old senator to graduate first to a walker, then to a cane – which he parked before mounting the stage unaided on Tuesday at a Fourth of July gathering sponsored by the Cobb County GOP. It was a silent message to those lusting after his job.

Another sign of a renewed Johnny Isakson: He’s planning an August town hall gathering with constituents. Isakson held two via telephone while he recuperated, and a third is in the works. But nationwide, physical gatherings have been scarce among Republican members of Congress faced with defending the repeal of Obamacare.

In Georgia, U.S. Rep. Buddy Carter of Savannah has been the only Republican to host a series of meetings with constituents. And that was back in February.

The specifics of one that features Isakson haven’t been settled. “I don’t want it to be an ambush location, but I also don’t want it to be a phony location,” he said.

But back to health care.

Isakson can’t accurately be described as a Republican swing vote, but he has his requirements – which I asked him to name.

He wants health insurance policies sold across state lines. He wants the number of essential benefits now mandated by Obamacare reduced, in order to promote diversity in policies offered by insurance companies. A competitive health insurance environment is necessary to make a Republican overhaul work, he maintains.

Isakson knows there’s a balance to be struck here. The greatest sin of Obamacare, the senator said, was the “bronze policy” that offered low premiums, but had such a high deductible that it has been nearly useless. A policy-holder might be protected from the catastrophic costs of cancer, only to be bankrupted by a broken leg.

Last week, U.S. Sen. Ted Cruz, R-Texas, and his allies pitched an idea for Republican consideration: Allow insurance companies to sell any kind of health insurance policy they want — as long as they also sell at least one plan that meets ACA requirements.

I asked Isakson about the idea. He didn’t dismiss it. “You could stay in business offering a policy nobody would buy, and satisfy the law,” he said.

But Isakson grew less enamored as he went on. “If it’s a crappy policy, it doesn’t do anything to solve anything. In fact, it’s kind of like what Obama sold everybody on the bronze policy,” he said.

Insurance companies would get their premiums, but illnesses and conditions that were uncovered would still leave hospitals holding the bag.

Hospitals are Isakson’s focus. The Senate Republican drafts so far would curtail the expansion of Medicaid, to the point that Congressional Budget Office scoring says 22 million Americans would lose coverage over the next decade. Gov. Nathan Deal never accepted the federal cash that would have allowed expansion in Georgia, so many state hospitals remain in a precarious financial position – especially in rural portions of the state.

When Obamcare was passed, federal payments to hospitals tasked with heavy loads of charity work – such as Grady Memorial in Atlanta and Memorial Health in Savannah — were to be phased out. Medicaid expansion was to have solved the problem. Those extra payments disappear in four-and-a-half years.

Isakson wants those payments restored — permanently. “America’s not going to be a country that leaves its poor on the doorsteps of hospitals, dying because they can’t get treatment. We’re smart enough to figure something out.

“There’ll be some contribution for hospitals that take on the charity patients, and I think a lot of it will come from not-for-profits,” Isakson said.

The senator was speaking of those hospitals that are public and non-profit in name, but are operated by private management companies that do very well, thank you. We have them here in Georgia, but it’s a national phenomenon.

For the last several years, the Legislature has approved a “bed tax” paid by all Georgia hospitals in order to build a pool of cash that can be used by the state to draw down matching federal Medicaid dollars.

It sounds like Isakson’s thinking of a nationalized version of this.

The deal-making begins on Tuesday.

Reader Comments 0

99 comments
John McGowan
John McGowan

Beware of our so-called leaders in DC. All you have to do is follow their actions. In other words, they lie. How can a government allow a over 65% fraud rate on Obamaphones run a country this large without a massive waste of money. Someone is getting very rich and folks it not the tax payer.

Tracy Dodd
Tracy Dodd

2018 Democrats will take over and change voting laws ending the Republican Party and Capitalism

Louis Sartor
Louis Sartor

I understand the opposition to being forced to buy private insurance. That's why so many of us support Medicare For All. Universal health care is the norm in all industrialized nations except the USA. I hope the senator makes a full recovery but I would bet his health care coverage is better than anyone that I know.

Angela Dawn Selden
Angela Dawn Selden

NO MANDATES!! How aboiut that! Let us be in charge of our own Healthcare! I agree the Insurance Companies need to be reigned in!

Ellen L Wright
Ellen L Wright

Isakson is a bought man. He does whatever he is told to do right down the party line. His words are the same as mcconnell's who is also bought. This is corruption on a grand scale.

Barbara Watkins
Barbara Watkins

Must be nice not to have to worry about insurance. You know the one we subsidize for you Senator.

Wayne Chastain
Wayne Chastain

Hey how do u sleep at night knowing that u have better insurance than the people u represent. We as American people are sick and tired of the very people that were hired to represent us have better benefits than the people that hired them.Politics is changing Johnny that's why Donald Trump got elected sleep well Johnny I hope you think on this ever time you sit in front of your pastor and maybe u should listen closer to him remember the 10 commandments treat others as u would treat yourself. Maybe people just like u started the ungodlessness in America

Denise Edwards
Denise Edwards

I don't care whose idea it was it's wrong, but have to pass it to see it polosi and the idiots both dem and rep are to blam to begin with.

Shawn Steen
Shawn Steen

This is why I dont support him tired of the double speak

Elizabeth Chapman
Elizabeth Chapman

NO ONE has the Right nor Authority to FORCE an Individual to BUY nor Supplement Another's Buying of any Commodity ~ That IS SLAVERY!!! And ANTI-American... We Voted in TRUMP to TERMINATE Such EVIL.

Kevin Morgan
Kevin Morgan

JFC, the derp is strong with this one. Evil? Really? It's evil to expect people to be prepared to cover their health care costs if they get sick? With the alternative being, we get to watch you die in the street, or WE pay out of pocket to cover the health care you couldn't be bothered to buy? And you're a nurse. How despicable a person you must be.

Elizabeth Chapman
Elizabeth Chapman

Barbara Watkins I VOTED in an American PATRIOT~ he Replaced the Criminal of all Criminals who did his best to destroy the U.S.A. so his Beloved One World Order of Globalists Elites could Rule the World of Ignorant Masses who simply want to know what they'll get out of it for Free. May God Save America!

Angie Parham
Angie Parham

But we r forced to buy car insurance\U0001f601

Pete Hardie
Pete Hardie

In other words, 'repeal and replace; has become 'claim credit for and adjust'

Keith Taylor
Keith Taylor

You promised to repeal it. Lets go with Tom Prices plan.

Chris Le Fave
Chris Le Fave

NO MANDATE WHATSOEVER! IF THE BILL IS SO GREAT, WHY DO YOU NEED A MANDATE? NO MANDATE! NO MANDATE! NO MANDATE!

Sybil Lee
Sybil Lee

We want you to work in Washington with our President and congress to repeal and replace Obamacare with new health care

Joe Eldred
Joe Eldred

#FullRepealNoDeal #StandWithRand #UnitedForFreedom

Chris Wright
Chris Wright

Retire Johnny. Freaking A. You can't drive down the costs of health insurance without a mandate. I'm sorry but you can't. That's why single payer countries have lower costs than us now. Everybody is covered and nobody is left out. If you don't have a mandate, who will have the insurance? Probably sick and older folks. What will profit driven companies do? DRIVE up the costs to compensate for it.

Prince Phillips
Prince Phillips

Hey, here's a novel idea!!! How about work together make an awesome healthcare plan and then move on to fixing this shitty poor and middle class penalizing tax system.

Prince Phillips
Prince Phillips

I wish the Republican Party would just stop this nonsense with healthcare. ACA is their plan Obama and the Democrats took it and made it their own. This plan originally came from the Heritage Foundation a Conservative think tank. Just fix it and stop the madness.

Tim Hotle
Tim Hotle

SIMPLY repeal it. Then you can think about a bill that is optional and market driven.

Rick Day
Rick Day

Such a wise rich government employee.

Justin Hughes
Justin Hughes

Just leave ACA, it is the republican plan. It is not Obamacare. It is Heritage Group care.

Ginny Hordines
Ginny Hordines

It sounds like Isakson actually understands what health insurance is andhow it works!

Amanda Ruf
Amanda Ruf

Republicans have lied about the mandate. But thanks for voting for them.

Nelms Graham
Nelms Graham

ObamaCare as the Supreme Court said, is a tax, and mainly on the middle class. If you like it then you must not be paying for it!

David K Wilson
David K Wilson

Repubs have nothing. But then neither do the Dems and Obamacare is a train wreck.

Lowell Ford
Lowell Ford

quote; { He wants the number of essential benefits now mandated by Obamacare reduced, in order to promote diversity in policies offered by insurance companies. } Selling health insurance with caps and lifetime limits and exclusions is what got the country going bankrupt years back and why the ACA was developed in the first place. People need Full-Coverage whether they think they need it or not. First car accident or major illness, the tax-payer is sent the bill or Hospitals and Clinics start closing again. Medicare for all, not-for-profit insurance management companies. Car Insurance rates would lower, no need for health coverage if an accident, home-owners would lower...if every American was 100% covered there would be no need for extra coverages.

Carole Mellin
Carole Mellin

Virginia Chastain Insurance companies will laugh in the face of anyone who is old, overweight, has high blood pressure, seasonal allergies, or any other "pre existing condition".

Carole Mellin
Carole Mellin

Insurance companies will laugh in the face of anyone who is old, overweight, has high blood pressure, seasonal allergies, or any other "pre existing condition".

Virginia Hodges
Virginia Hodges

He is lying . Read it see if it makes sense. It can't work without a mandate and they all know it. Lairs

Mark Faucette
Mark Faucette

Tom, you took the words right off my keyboard. What the hell does that even mean?

Katherine White
Katherine White

I wonder how much stock Johnny bought in United Health?

Barbara Austen Cheng
Barbara Austen Cheng

WTH? Seriously. Does he even know what he's saying anymore? Or even care?

Paige R. Penland
Paige R. Penland

The GOP has been promising to get rid of the individual mandate for years. I considered that one of the silver linings of Trump's win in November. At least we wouldn't be asking Millennials beset with student debt and endless internships to subsidize their older and presumably more financially stable compatriots. Yes, I understand that the mandate mitigates the risk pool and is a necessary component of Obamacare, I'm a social democrat. But if we're going to deregulate the energy sector, destroy the environment, pull out of the Paris accords/NAFTA/NATO/UN/TPP/etc, cut taxes for the 1%, roll back social services and public transport, make "princess" a legitimate government job, and otherwise go all in on destroying the Republic, why not? Give the kids a break, since we're destroying their future so some two-bit autocrat can get his revenge on a world that has always laughed at him, rather than with him. NOPE. Only the rich get tax cuts under this regime, not the working poor. Oh well.

Don Brewer
Don Brewer

This should never have gotten to the point where healthcare in the richest country in the world, ever, is decided by politicians.

John Smith
John Smith

YOU LEFT WING RADICALS SAID NOTHING.... You said nothing when Obama used drone strikes to execute people abroad. You said nothing about Russia for 50 years until Trump was inaugurated. You said nothing about Hillary’s campaign manager’s brother being paid $175,000 to lift U.S. sanctions on Russia. You said nothing when Obama engaged in military interventionism in Libya without Congressional approval. You said nothing Obama greatly expanded presidential power through the use of Executive Orders. 6. You said nothing when Obama filled his White House with lobbyists after he said he wouldn’t. 7. You said nothing when Obama gave 47 of his fundraisers Administration jobs. 8. You said nothing about the murders and rapes at the hands of illegal immigrants. 9. You said nothing when Hillary’s net worth rose over $100 million as Secretary of State, in part, because her husband took money from foreign governments. 10. You said nothing after Obama’s net worth rose over $10 million as President. 11. You said nothing when Obama’s Justice Dept. Wiretapped/surveilled reporters such as James Rosen and the AP. 12. You said nothing when Obama restricted immigration 6 times with Executive Orders. 13. You said nothing when Obama set a record for deportations. 14. You said nothing when Bill Clinton met Loretta Lynch on the airport tarmac during the Clinton investigation. 15. You said nothing when Hillary was fed debate questions. 16. You said nothing when Obama and Hillary lied about a video and Benghazi. 17. You said nothing when Obama’s IRS abused the rights of taxpayers. 18. You said nothing when Obama’s White House held meetings with lobbyists in coffee shops near the White House to avoid disclosure requirements. 19. You said nothing when Eric Holder sold the guns you hate to criminals and some were used to kill Americans. 20. You said nothing when the Clinton’s took White House property. 21. You said nothing when Hillary laughed off defending a child-rapist. 22. You said nothing when Hillary lied about her private use of a private email server as Secretary of State. 23. You said nothing when Janet Reno, under Bill Clinton, used a tank to kill the Branch Dividians. 24. You said nothing when, on May 13, 1985, a bomb was dropped on a row house in Philadelphia to uproot the black liberation group known as Move, resulting in a fire that eventually burned down 61 houses, killed 11 people (including five children) And injured dozens. 25. You said nothing was Elian Gonzales was forcibly deported using guns. 26. You said nothing when George Soros paid protesters to burn parts of Ferguson. 27. You said nothing about states’ rights until Trump's Executive orders on immigration. 28. You said nothing about Obama’s smoking. 29. You said nothing about the record numbers of people on government assistance. 30. You said nothing about the number of part time and low paying jobs under the Obama recovery. 31. You said nothing when Obama had SWAT teams raid a Gibson guitar factory and seize property, on the purported basis that Gibson had broken India’s environmental laws—but no charges were filed. 32. You said nothing when Obama claimed that the Fort Hood shooting was “workplace violence” rather than terrorism. 33. You said nothing about when Obama ended some terror asylum restrictions, by allowing asylum for people who provided only “insignificant” or “limited” material support of terrorists. 34. You said nothing when the national debt doubled under Obama. 35. You said nothing when 9 times the Supreme Court unanimously overturned Obama’s expansive use of Executive Power. 36. You said nothing when Obama dismissed charges filed by Bush Administration against New Black Panther Party members who were videotaped intimidating voters at a Philadelphia polling station during the 2008 election. 37. You said nothing when Obama released Guantanamo detainees were released and went back to kill Americans. 38. You said nothing when Obama unilaterally changed Congressional law by Executive Order. 39. You said nothing when Obama fired an inspector general after investigating an $850,000 AmeriCorps grant received by a nonprofit run by former NBA star and Obama supporter Kevin Johnson. 40. You said nothing about the 36 Obama’s executive office staffers that owed $833,970 in back taxes 41. You said nothing when Obama Killed four Americans overseas in counterterrorism operations without a judicial process. So if you are voicing your objections about the months of Trump, I’m sorry... we can't hear you because you said NOTHING before!!! Keep this going! Copy and share on every liberal response!

Carole Mellin
Carole Mellin

And now YOU are saying nothing when the worst attack on our country since 9/11 is happening.

Gina Banks
Gina Banks

You bring up examples of Obama and Clinton, but there are things the other 42 presidents did that weren't the greatest either. Especially from the Bush family!!!! Trump has shamed America since taking office, and has made it his priority to simply try and erase Obama's presidency. To hate someone has much as Trump hates Obama is crazy!!! And for all who genuinely support trump, speaks highly of their character and heart!!

Mt Fieldz
Mt Fieldz

Wow! You can copy and paste! I'm actually surprised!