Financial & Health Care Reforms Highlight Republicans Desire for More Politics, Less Change

Published: Thu 22 Apr 2010

Mary Banks

Republicans supported President Obama's health insurance mandate before recently opposing it.

The mandate in the new health care reform law is actually a Republican notion that has existed for at least 20 years. During Bill and Hillary's attempt to overhaul health care, the Republicans suggested it as a viable alternative to the Clinton plan. Now, Republicans refer to the coverage mandate as government overreach.

In 2006, Mitt Romney, currently eying another run for the Republican presidential nomination, signed a health insurance mandate into law as the governor of Massachusetts. When he did, he called it a "personal responsibility principle" and Republican senator Scott Brown of Massachusetts supported it. Now, Romney calls Obama's plan a federal takeover that in no way resembles the law he signed as governor and insists that it be repealed.

Republicans claim the Obama administration co-opted their original idea, taking away a proposed mechanism for minimizing costs. Over twelve Republican attorneys general are prepared to challenge the coverage mandate as unconstitutional in federal court.

About the Mandate

Beginning in 2014, the health care law will mandate that almost all Americans have medical insurance through their employers, the government, or an individual plan. In 2014, health insurance plans must accept all applicants, new medical insurance markets will open for business, and millions of people will start receiving tax credits to help them afford the premiums.

Those who refuse to purchase coverage must pay the IRS a penalty, except in the event of financial hardship. Fees will vary by family size and income level. For instance, a single person with an annual income of $45,000 would pay an additional $1,125 in income taxes when the penalty reaches its full phase in 2016.

Today's conservatives reject that plan. Just a little while ago, most of them regarded a national coverage mandate as a free-market solution to get coverage to all Americans and an alternative to government-run entitlement programs like Medicaid and Medicare. Most industry experts believe that some sort of mandate is necessary in a reformed health care system because medical insurance can't work if people can postpone joining the risk pool until they are ill.

Republican Flip-Flop

During the 1970s, President Nixon supported a mandate that would have forced employers to offer medical insurance. During the 1990s, a conservative think tank called the Heritage Foundation endorsed an individual health insurance requirement. Apparently, the party has changed its mind.

"The idea of an individual mandate as an alternative to single-payer was a Republican idea," explained health economist Mark Pauly of Penn's Wharton School. In 1991, Pauly published an article that outlined how a coverage mandate could be joined with tax credits - two principles that are now included in Obama's law. Pauly's theories were well-received by the administration of George H.W. Bush.

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