Democrats have come to believe that Obamacare’s health insurance mandate requiring people to have government-approved health insurance is so toxic that they are accusing Republicans of supporting it.
The issue has emerged in Virginia where Republican Ed Gillespie is challenging incumbent Democratic Senator Mark Warner, who voted for Obamacare. Indeed, since it took every Democratic senator’s vote to get the 60 votes needed, one can say that Warner’s vote provided that final necessary vote.
Now Democrats are accusing Gillespie of supporting an individual mandate long before the Democrats’ law made it a household pariah.
A Virginia Democratic Party political ad features Gillespie on C-Span in 2006 discussing his new book in which he says some Republicans might be open to an individual mandate. And he was correct; a few Republicans were open to a mandate years ago.
But the ad conveniently fails to include the rest of Gillespie’s comments (about 8:30 on the clip), in which he suggests other reform options.
Democrats are also trying to connect Gillespie to Mitt Romney’s 2006 health care reform in Massachusetts, which included an individual mandate. However, Romney soon tried to separate himself from that mandate.
In early 2007, the fledgling Romney-for-president campaign asked several conservatives with extensive health policy backgrounds for comments on federal health care reform. Several of us stressed that we would not support a national mandate to have coverage. Romney’s aide, who had helped get Romneycare passed in the Bay State, pointed out that he didn’t include a mandate in his original version of the legislation. The only reason it was inserted was that Democrats in the legislature demanded it.
Now, Romney can be faulted for signing the legislation and then defending it, but let’s at least be clear about who demanded the coverage mandate.
In addition, Democrats are pointing to the health care reform section in Gillespie’s 2006 book. But his proposal takes the approach embraced by the anti-mandate people, not the pro-mandate side.
Since Bill and Hillary Clinton put national health care reform on the table, there have been two fundamentally different approaches to trying to expand insurance coverage. The “stick approach” was the mandate to have coverage or face a penalty, which Chief Justice John Roberts retroactively decided to call a tax.
The “carrot approach,” which was supported by the vast majority of conservatives and free market advocates, was to use the tax system to encourage people to buy health insurance. That’s why National Center for Policy Analysis President John Goodman called it “universal coverage without mandates.”
Currently, the federal government “loses” about $250 billion a year in revenue due to the tax break for health insurance. The free market side asked whether there was a way to restructure that current tax break to get more people to sign up for coverage.
One proposal was to end the “tax exclusion” for employer-provided health insurance. Everyone would pay taxes on what employers spent on employee health insurance, but every American would get an individual tax break. President George W. Bush proposed a standard deduction of $7,500 for an individual and $15,000 for a family. As a presidential candidate, John McCain proposed a $5,000 refundable tax creditfor each family, which is calculated differently from a deduction.
But what do you do about the “free rider” problem—people who refuse to sign up for coverage but then get care when they show up at the emergency room, often at taxpayer expense?
The NCPA’s Goodman, a leading opponent of an insurance mandate, pointed out years ago that when the uninsured forgo their tax break, that money is left at the federal level, but if the uninsured need care they are going to get it at the local level. So he proposed a way to transfer that tax money from the federal level to the state or local level, in essence indirectly covering the cost of the uninsureds’ care.
There is nothing radical about such an approach; the federal government has been doing it for years through the “disproportionate share” (DSH) payments. The feds give grants to hospitals that provide care to a disproportionate share of the uninsured. The Goodman approach would have just created a rational basis for how much money hospitals received. Gillespie’s book suggests a way to make that transition. In short, Gillespie is clearly embracing the anti-mandate approach.
It’s telling that Democrats are accusing Republicans of supporting what they passed and are now running from. If Obamacare had turned out to be as popular as most of the Democrats believed it would, they’d be attacking Gillespie for not backing a health insurance mandate. At least they’d have a basis for that claim.