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Health insurance mandate began as a Republican idea

In ’90s, GOP saw an alternative to Clinton plan

By Ricardo Alonso-Zaldivar
Associated Press / March 28, 2010

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WASHINGTON — Republicans were for President Obama’s requirement that Americans get health insurance before they were against it.

The obligation in the new health care law is a Republican idea that has been around at least two decades. It was once trumpeted as an alternative to Bill and Hillary Rodham Clinton’s failed health care overhaul in the 1990s. These days, Republicans call it government overreach.

Mitt Romney, weighing another run for the GOP presidential nomination, signed such a requirement into law at the state level as Massachusetts governor in 2006. At the time, Romney defended it as “a personal responsibility principle’’ and Massachusetts’ newest GOP senator, Scott Brown, backed it. Romney now says Obama’s plan is a federal takeover that bears little resemblance to what he did as governor and should be repealed.

Republicans say Obama and the Democrats co-opted their original concept, minus a mechanism they proposed for controlling costs. More than a dozen GOP attorneys general are determined to challenge the requirement in federal court as unconstitutional.

Starting in 2014, the new law will require nearly all Americans to have health insurance through an employer, a government program, or by buying it directly. That year, new insurance markets will open for business, health plans will be required to accept all applicants, and tax credits will start flowing to millions of people, helping them pay the premiums.

Those without coverage will have to pay a penalty to the IRS, except in cases of financial hardship. Fines will vary by income and family size. For example, a single person making $45,000 would pay an extra $1,125 in taxes when the penalty is fully phased in, in 2016.

Conservatives say that is unacceptable. Not long ago, many of them saw a national mandate as a free-market route to guarantee coverage for all Americans — the answer to liberal ambitions for a government-run entitlement like Medicare. Most specialists agree some requirement is needed in a reformed system because health insurance does not work if people can put off joining the risk pool until they get sick.

In the early 1970s, President Nixon favored a mandate that employers provide insurance. In the 1990s, the Heritage Foundation, a conservative think tank, embraced an individual requirement. Not anymore.

“The idea of an individual mandate as an alternative to single-payer was a Republican idea,’’ said health economist Mark Pauly of the University of Pennsylvania’s Wharton School. In 1991, he published a paper that explained how a mandate could be combined with tax credits — two ideas that are now part of Obama’s law. Pauly’s paper was well-received — by the George H.W. Bush administration.

“It could have been the basis for a bipartisan compromise, but it wasn’t,’’ said Pauly. “Because the Democrats were in favor, the Republicans more or less had to be against it.’’

Obama rejected a key part of Pauly’s proposal: doing away with the tax-free status of employer-sponsored health care and replacing it with a standard tax credit for all Americans.

Romney’s success in Massachusetts with a bipartisan health plan that featured a mandate put the idea on the table for the 2008 presidential candidates.

Brown, whose election to replace the late Democratic Edward M. Kennedy almost led to the collapse of Obama’s plan, said his opposition to the new law is over tax increases, Medicare cuts, and federal overreach on a matter that he says should be left up to states. Not so much the requirement, which he voted for as a state lawmaker. “In Massachusetts, it helped us deal with the very real problem of uncompensated care,’’ Brown said.