Zaniya: Insurance Mandate Killed by Lack of Income Tax?

The "unattributed comments" attached to the Zaniya Project Task Force final report may enlighten us as to what happened to the "personal responsibility" mandate to buy health insurance. This Massachusetts-style mandate reared its ugly head as Recommendation #14 in the Zaniya draft proposal but disappeared in the final report, replaced by a limp endorsement of "a work group to promote personal responsibility." (No mention, of course, of promoting corporate or social responsibility... but that's another post.)

Whither the mandate? One word: enforcement. Said certain anonymous Zaniya members:

1. There are significant issues relative to enforcing a financial responsibility requirement, which make the feasibility of this recommendation dubious.
2. I think financial responsibility is a good concept if it were enforceable. Unfortunately, enforcement mechanisms are limited in this scenario. It’s a little bit hard to imagine putting someone in jail because they don’t have health insurance. I think this should be deleted.
3. Extremely problematic way of installing an individual mandate. The state does not have any mechanism to evaluate on an annual basis the income and asset levels of every resident of the state nor does such a system take into account the large fluctuations in agricultural income on a year to year basis. In essence, you will be data mining from a multitude of sources to try and determine the income and assets of every South Dakota to determine their “willingness and ability” to pay for health insurance.
4. This is very good idea in theory but that is where it ends. Similar to automobile insurance financial responsibility the enforcement piece would be a nightmare. In fact, I believe it a health insurance financial responsibility standard would be unenforceable. This is not a workable idea or solution to help the uninsured population in SD.
   
5. Don’t support this. This is not workable – can’t be done.
6. The recommendation lacks any realistic enforcement mechanism and puts all front line healthcare providers in the position of the “financial responsibility” cop. This recommendation needs to be deleted. [emphasis in original]
   

But wait a minute: Massachusetts must have a way to enforce its mandate. If we copy their mandate, couldn't we just copy their enforcement mechanism? How do they do it?

Beginning in 2007, Massachusetts state law will require residents to report health insurance status on their income tax returns.

Doh! No wonder Zaniya killed the mandate! The mandate would have depended on income levels. The state would have needed documentation of individual incomes. But with no income tax, the state doesn't have access to that information.

Yeah, yeah, yeah, I can hear my commenters already: "Ha ha ha -- bet you're glad there's no income tax now!" State income tax to replace property and sales tax is still a good idea, but it's still politically a long way away. In the meantime, if the lack of an income tax mechanism was the undoing of the insurance mandate, well, I'll take my victories where I can get them. Unless the legislature gets ambitious (did I hear someone chuckle?), we've staved off the insurance mandate long enough to watch the Massachusetts plan founder and fail. Saved by our regressive tax structure! Hooray.