Why Republicans Abandoned the Mandate

THE POLITICAL SCENE UNPOPULAR MANDATE.Why do politicians reverse their positions?
by Ezra Klein
JUNE 25, 2012 Republicans turned against the individual mandate after supporting it for two decades.


On March 23, 2010, the day that President Obama signed the Affordable Care Act into law, fourteen state attorneys general filed suit against the law’s requirement that most Americans purchase health insurance, on the ground that it was unconstitutional. It was hard to find a law professor in the country who took them seriously. “The argument about constitutionality is, if not frivolous, close to it,” Sanford Levinson, a University of Texas law-school professor, told the McClatchy newspapers. Erwin Chemerinsky, the dean of the law school at the University of California at Irvine, told the Times, “There is no case law, post 1937, that would support an individual’s right not to buy health care if the government wants to mandate it.” Orin Kerr, a George Washington University professor who had clerked for Justice Anthony Kennedy, said, “There is a less than one-per-cent chance that the courts will invalidate the individual mandate.” Today, as the Supreme Court prepares to hand down its decision on the law, Kerr puts the chance that it will overturn the mandate—almost certainly on a party-line vote—at closer to “fifty-fifty.” The Republicans have made the individual mandate the element most likely to undo the President’s health-care law. The irony is that the Democrats adopted it in the first place because they thought that it would help them secure conservative support. It had, after all, been at the heart of Republican health-care reforms for two decades.

The mandate made its political début in a 1989 Heritage Foundation brief titled “Assuring Affordable Health Care for All Americans,” as a counterpoint to the single-payer system and the employer mandate, which were favored in Democratic circles. In the brief, Stuart Butler, the foundation’s health-care expert, argued, “Many states now require passengers in automobiles to wear seat-belts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.” The mandate made its first legislative appearance in 1993, in the Health Equity and Access Reform Today Act—the Republicans’ alternative to President Clinton’s health-reform bill—which was sponsored by John Chafee, of Rhode Island, and co-sponsored by eighteen Republicans, including Bob Dole, who was then the Senate Minority Leader.

After the Clinton bill, which called for an employer mandate, failed, Democrats came to recognize the opportunity that the Chafee bill had presented. In “The System,” David Broder and Haynes Johnson’s history of the health-care wars of the nineties, Bill Clinton concedes that it was the best chance he had of reaching a bipartisan compromise. “It should have been right then, or the day after they presented their bill, where I should have tried to have a direct understanding with Dole,” he said.

Ten years later, Senator Ron Wyden, an Oregon Democrat, began picking his way back through the history—he read “The System” four times—and he, too, came to focus on the Chafee bill. He began building a proposal around the individual mandate, and tested it out on both Democrats and Republicans. “Between 2004 and 2008, I saw over eighty members of the Senate, and there were very few who objected,” Wyden says. In December, 2006, he unveiled the Healthy Americans Act. In May, 2007, Bob Bennett, a Utah Republican, who had been a sponsor of the Chafee bill, joined him. Wyden-Bennett was eventually co-sponsored by eleven Republicans and nine Democrats, receiving more bipartisan support than any universal health-care proposal in the history of the Senate. It even caught the eye of the Republican Presidential aspirants. In a June, 2009, interview on “Meet the Press,” Mitt Romney, who, as governor of Massachusetts, had signed a universal health-care bill with an individual mandate, said that Wyden-Bennett was a plan “that a number of Republicans think is a very good health-care plan—one that we support.”



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TPM Editor’s Blog
Why Republicans Abandoned The Mandate, Take XXVVIII

BRIAN BEUTLER JUNE 18, 2012, 3:35 PM 13234
Ezra Klein explores the GOP’s unanimous turn against the individual mandate as an example of motivated reasoning: Partisans convincing themselves that their prior views about health care policy were wrong in order to deny political enemies a key victory.

I have a very different read. And I think it can be applied broadly — not just to the mandate, but to cap-and-trade legislation, the payroll tax cut, policy objectives on both sides of the aisle.

But let’s look at the mandate. Yes, denying President Obama a political victory was obviously an important motivator, but it understates the extent to which Republicans have a genuine commitment to purpose that extends far beyond beating Democrats. And so it’s actually no surprised that they aren’t terribly fazed about accusations of cynicism when their imperatives require 180 degree strategic turns.

That’s not intended as a criticism.

If you take public policy seriously, then it makes sense to maximize opportunities and minimize defeats irrespective of strategic or procedural consistency. When the goal was passing the Bush tax cuts, Republicans used the budget process in a controversial way to get the job done. When Democrats used the same process to round out health care reform, Republicans took a hard line against it. It’s cynical politics. But if you believe in the Bush tax cuts and you want to stop health care reform, it’s the right thing to do.

You can apply a similar test to the GOP’s treatment of the individual mandate. The mandate arose as a conservative alternative to more liberal health care reforms like single payer and “Clintoncare.” The goal was to have something fully baked and ready to serve up in the event that something farther reaching gained traction in Congress. Years later, when Democrats recognized that a mandate-based private insurance system was their best shot at achieving universal health care, Republicans abandoned it. On the surface it was schizophrenic, and suggested a certain nihilism about public policy. But apply a frame in which parties seek to maximize policy gains and minimize policy losses, and suddenly the GOP’s actions make perfect sense. The conservative movement is heavily invested in limiting the size of the federal welfare state, particularly publicly run parts of it. A mandate was a perfect instrument for hedging against the risk of Medicare for All, or another single payer-like approach. But once that risk had disappeared so did the strategic value of the individual mandate. When Democrats embraced the mandate, restraining the growth of the safety net required Republicans to create a united front against it. So that’s what they did. No apologies.

Whether or not three years on Republicans who once supported the idea have convinced themselves earnestly that their old views were wrongheaded is largely beside the point. As far as how politicians make and pursue policy goes, “motivated reasoning” doesn’t provide a great deal of explanatory value.

N.B. In anticipation of some obvious counterexamples, obviously this model doesn’t explain everything. But before you scream “Medicare Part D,” consider that seeding public entitlements with private options — and that’s fundamentally what Medicare Part D is — is consistent with the broader goal of unwinding the public safety net. Obviously there were other political considerations at the time. And debt-financing the expansion of an existing entitlement — even with a private system — put the GOP on the wrong side of some very powerful conservative advocates. It’s hard to square that with an explanatory framework in which elected Republicans consistently try to limit the growth of the safety net. But the particulars of the Medicare Part D saga are unusual enough that I think it’s fair to view that fight as an outlier.

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Some 3.1 million young adults have health insurance as a result of the health care reform law, according to new figures released Tuesday by the Obama administration.

That’s up from 2.5 million in December 2011, a similar report found then.

“Today, because of the health care law, more than 3 million more young adults have health insurance,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “This policy doesn’t just give young adults and their families peace of mind, it also gives them freedom. It means that as they begin their careers, they will be free to make choices based on what they want to do, not on where they can get health insurance.”

A provision in the Affordable Care Act permits young adults to remain on a parent’s insurance policy until age 26. It remains a widely popular part of the law, one that Democrats have sought to highlight.

The news comes just days ahead of an expected Supreme Court ruling on the constitutionality of the law. The prospect “Obamacare” could be thrown out has left numerous Republicans sympathizing with the under-26 provision and other well-liked components, lest they be blamed for the damaging disruptions their efforts could cause.

But they haven’t backed off their vow to repeal the health care law entirely.

“Unless the Supreme Court throws out the entire Obamacare bill, the House will move to repeal all of it,” House Speaker John Boehner (R-OH) said Tuesday. “And then what we’ll do is move in a step-by-step approach to common-sense reforms that will lower the cost of health insurance and ensure that the American people can go to the doctor of their choice.”