There has been a great deal of discussion about the threats to the First Amendment religious liberty rights of organizations and individuals, and to liberty generally, posed by the Obama Administration’s mandate  that private health insurers include contraception and abortion-inducing drugs in private insurance plans (“Contraception-Abortion Mandate”). And there is pending litigation and legislation to undo this mandate. Here, in essays on three consecutive days essays, I describe three broad ways forward.

Today: replacing Obamacare’s government mandates with competitively priced, individually-owned, health insurance.

Tomorrow: encouraging religious institutions to rededicate themselves to their mission.

The Following Day: expanding the number of employees of churches and members of religious, including ecumenical religious, orders.

(To those people who object to my use of “Obamacare,” I suggest that they do protest too much. Normally, a piece of legislation named after a person who campaigned for it, who considers it a singular achievement for himself and the country, and whose name conveys that the person “cares,” could not possibly be considered derisive.)

Today: Replacing Obamacare’s Government Mandate with Competitively Priced, Individually-Owned, Health Insurance

 To those who have followed the health insurance policy debate over the past 20 years, since at least HillaryCare of 1993, the elements of an alternative to Obamacare consistent with American principles of government are well known. They were reflected in Senator McCain’s 2008 presidential campaign program and are reflected in the presidential campaigns this year of at least Speaker Gingrich, Governor Romney and Senator Santorum. Unfortunately, it does not appear that the elements of the alternative are well known among the electorate.

There are two parts. Either part by itself would make a huge difference, but together they would really be effective in promoting individual freedom and health while reducing costs. I offer this rule of thumb: We citizens should expect that any piece of legislation that promotes individual freedom and reduces cost, as this one would, could be explained in a few words, would be short enough to be read by legislators and citizens, and would offer a framework for action by individuals – not mandates, not micromanagement, not taxes, not more bureaucracy, not more federal employees, not more paperwork. This legislation would meet these criteria.

The two parts are:

--eliminating monopolies of health insurance providers within the states
--providing for the purchase of insurance policies independent of employers

First, Congress would invoke its powers under the Commerce Clause which, in its original meaning, allowed Congress to remove state barriers to commerce, by ensuring that health insurance providers could sell insurance across state lines. Currently, many states have just one or two insurance providers. This change would eliminate these monopolies and provide additional choices and price competition.

Second, Congress would help individuals purchase health insurance policies independent of their employers (who typically provide just one plan). Congress would provide a tax credit, tax deduction or the use of pre-tax dollars. Such insurance would be portable between jobs and would provide coverage when an individual is unemployed or under-employed or self-employed. For example, you could buy health insurance from Rotary International (which has nearly eradicated polio in India), Elks, Knights of Columbus, AARP, the National Rifle Association, a college alumni association, your union, a business trade association, the Susan G. Komen for the Cure Foundation, a stamp collectors association, Indiana Democrats, Wilderness Society, etc.

These are sometimes described in the policy debates as “association health plans” Each association/organization, consisting of hundreds of thousands of members, could offer multiple plans. Each would take advantage of group rates and pass these on to their members. This legislation would allow membership organizations and health insurers to engage in mutually beneficial affinity marketing. You choose – you choose one of the multiple organizations to which you or your spouse belongs and you choose one of the plans offered by that organization and you choose the coverage and the deductible. And you can choose later to change plans offered by an organization or choose a plan offered by another organization. Costs would fall due to the pressures of both the organizations and their members.

Take just one example: If associations were able to offer health insurance plans to their members, then one such plan could be a plan consistent with Catholic teaching. Thus, Catholic and non-Catholic members of Rotary International or of the University of Pittsburgh Alumni Association or of the United Association (of Pipefitters) could choose among a number of plans offered by these organizations. The plans could be secular plans that do not cover contraception or abortion or plans sponsored by the Knights of Columbus or Chicago’s Mercy Hospital or the Religious Sisters of Mercy or the Catholic Medical Association (and its 600 hospitals).

President Obama has repeatedly asserted that he wants to engage in nation-building here at home. Nation-building, as Americans understand it, includes the growth of organizations of civil society, intermediaries between the individual and the government. A hallmark of American democracy is its plenitude of associations. Alexis de Tocqueville made this well-known observation in his book Democracy in America published in the first half of the 19th century:

     In the United States, as soon as several inhabitants have taken an opinion or an idea they wish to promote in society, they seek each other out and unite together once they  have made contact. From that moment, they are no longer isolated but have become a power seen from afar whose activities serve as an example and whose words are heeded. 

If associations offered health insurance, not only to their employees but to their members, it would enhance all associational activity and would build this Nation.

Spero columnist James M. Thunder is a Washington DC-based attorney.

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