Health Mandate’s Affordable Care Act: What’s At Stake
|By John Lantigua, The Palm Beach Post, Fla.|
When it comes to the individual mandate in the Affordable Care Act, which the
Democrats who once opposed any mandate, including then-Sen.
But Butler did use the word "mandate" in his 1989 writings.
"Mandate all households to obtain adequate insurance," Butler wrote. "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."
In the early 1990s under
Some libertarians took issue with that position, but the foundation didn't budge.
"It is idle to talk about personal freedom outside of personal responsibility," foundation senior fellow
But Butler, Moffit and the foundation subsequently recanted.
"I've altered my views on many things," Butler wrote in his op-ed piece. "The individual mandate in health care is one of them."
Butler explained that he now believes strategies such as automatic enrollment in insurance programs, requiring a written statement to opt out, and large tax credits for health insurance spending will greatly increase coverage, making mandates unnecessary.
He said that even in 1989 he was speaking about a mandate not for comprehensive insurance, as contained in the current law, but primarily for catastrophic insurance -- although in a subsequent lecture he said a mandate "might also include certain very specific services, such as preventive care, well-baby visits and other items."
Moffit, in an interview with
"It was a policy endorsed by many conservative economists at the time, as well as the
"It was for catastrophic care and designed to stop free riders," Moffit said, referring to uninsured people who accumulate large hospital bills that fall to taxpayers.
But he said the foundation moved away from the idea of a mandate long before Obama was elected president. In the meantime, after
"The idea of a mandate was never a mainstream Republican position," Uscinski said. "It was discussed in a few pockets, but most Republicans were in favor of a free-market solution, not forcing people to buy something. The evolution of the Democrats is more interesting."
"That's part of it -- the fact that it originally had been a Republican idea," he said. "He probably figured this would be a consensus builder, but ultimately it wasn't."
Another influence on Democrats was the
"Kennedy worked a long time for universal health care and, yes, I'm sure the fact that he backed the
Democrats, many of whom had favored a more liberal public option, abandoned that idea when it became clear it would never pass in
But by that time, conservatives had abandoned their previous position. Then came the tea party movement, which has emphasized strict adherence to the Constitution. Many members consider the health care law creeping socialism and any federal mandate as unconstitutional.
"If we didn't have the deficits we have, if we were in better economic times, you might find some receptivity, but not now," she said.
In the end, FAU's Wagner finds the evolution of the positions intriguing. Although Obama may have expanded the idea that Butler first enunciated, Wagner sees a clear line leading from one to the other.
"Obama adopted an idea that originated with a conservative think tank and he gets labeled a socialist for it," said Wagner. "Now that's ironic."
(c)2012 The Palm Beach Post (West Palm Beach, Fla.)
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