The New York Times reported this afternoon that Senate Republicans have now altered their health care bill to include a provision that would penalize people who opt not to buy insurance. According to the article, people who go more than two months without insurance will have to wait six months for a new policy to take effect after they buy it.
This is an entirely reasonable change since it prevents the obvious problem that many people would have opted to game the system without a provision like this. As I and others pointed out, it would be a pretty low-risk proposition for healthy people, especially older ones who faced high premiums, to go without insurance and then buy insurance only if they developed a serious illness.
This would likely make the system unstable since it would mean that the pool of people in the system were less healthy than average, and therefore have higher health care expenses. This would raise costs and premium prices, leading more people to drop out. Eventually, only very unhealthy people would look to buy insurance, which would be extremely expensive.
For this reason, the penalty makes sense. What doesn't make sense is that the Republicans are just adding the provision now. This problem of adverse selection (only less healthy people buy insurance) is not a new discovery. It has been known to people writing about insurance for more than half a century. So how could the Republicans spend all this time hashing out a bill and only now realize that they have a problem?
This is yet another piece of evidence (as if more was needed) that this is not an effort to provide better insurance to the public, it is about giving tax cuts to rich people. The insurance aspect is a sidebar, sort of like when you buy cheese at the store and you need it wrapped in something. You don't really care what the cheese is wrapped in, you care about the cheese.
In the same vein, the Republicans don't really care what the insurance looks like, they care about the tax cuts for rich people. If they did care about the insurance, the penalty for going uninsured would not be a last minute addition.