In our last post we mentioned that if you look at the recent history of health care reform and what’s actually in the new law, the response from both parties seems off. Today we’ll look at the Republican response, and in our next post we’ll look at the Democrats.
Here’s why we don’t understand the Republicans’ all out attack on health care reform: Most of what’s in the new law are things they supported in the past.
1993: Republican Proposal for Health Reform
In response to the Clinton administration’s ultimately unsuccessful push for health care reform, the Republicans put forth their own bill– the Health Equity and Access Reform Today Act of 1993:
- The bill would have created a new system through which small businesses and individuals could purchase health insurance.
- It would have banned insurance companies from denying coverage or canceling coverage based on pre-existing conditions, they couldn’t charge more based on health status, and plans would have to provide certain minimum benefits.
- Individuals would have to buy insurance if they didn’t get it through their employer, but the government would provide assistance in the form of vouchers to those who couldn’t afford it.
When this bill was proposed by Senator John Chafee (R-RI) back in 1993 it attracted 18 Republican cosponsors, including some of the same senators who have called Obama’s plan a government takeover of health care. For example, Senator Orrin Hatch (R-Utah), called the current health reform law a “step-by-step approach to socialized medicine” that threatens the existence of the two-party system. He was a cosponsor of the 1993 Republican bill.
An even more recent example of Republicans supporting a health reform nearly identical to the Affordable Care Act, was in Massachusetts. Republican Governor Mitt Romney negotiated a health care bill with the Democratic controlled legislature in 2006 that:
- created exchanges for individuals to purchase private insurance;
- requires that everyone had insurance;
- provides subsidies for people who couldn’t afford it; and
- prevents insurance companies from denying or canceling coverage because of pre-existing conditions.
Again, sound familiar?
The Heritage Foundation, a leading conservative think tank (which counts Rush Limbaugh and Sean Hannity as proud members), worked with Mitt Romney and even sent representatives to the signing of the Massachusetts law. Yet they’ve aggressively attacked the same ideas in President Obama’s plan. The website Think Progress compiled a list of some of their most blatant contradictions:
– 2006, Heritage On Romney’s Individual Mandate: “Not an unreasonable position, and one that is clearly consistent with conservative values.” [Heritage, 1/28/06]
– 2009, Heritage On President Obama’s Individual Mandate: “Both unprecedented and unconstitutional.” [Heritage, 12/9/09]
– 2006, Heritage On Romney’s Insurance Exchange: An “innovative mechanism to promote real consumer choice.” [Heritage, 4/20/06]
– 2009, Heritage On President Obama’s Insurance Exchange: Creates a “de facto public option” by “grow[ing]” government control over healthcare.” [Heritage, 3/30/10]
– 2006, Heritage On Romney’s Medicaid Expansion: Reduced “the total cost to taxpayers” by taking people out of the “uncompensated care pool.” [Heritage, 1/28/06]
– 2009, Heritage On President Obama’s Medicaid Expansion: Expands a “broken entitlement program,” providing a “low-quality, poorly functioning program.” [Heritage, 3/30/10]
Why the all-out attacks then?
Given this history, it’s hard to believe that most Republican leaders really think Obama and the Democrats’ approach to health reform is a socialist “government takeover.” Sure there may have been elements that they disagreed with, but they could have negotiated to change certain provisions in exchange for voting yes on the final bill.
They didn’t. The only Republicans who even hinted that they might vote for the final bill were from Maine. Republicans instead decided to take Weekly Standard editor Bill Kristol’s advice:
“With Obamacare on the ropes, there will be a temptation for opponents to let up on their criticism, and to try to appear constructive, or at least responsible. My advice, for what it’s worth:
Resist the temptation. This is no time to pull punches. Go for the kill.”
It appears that Republicans tried to kill the bill, not because they thought it was fundamentally bad policy, but simply because it would help them politically. In the words of Rep. Jim Demint, they hoped it would be Obama’s “Waterloo. It will break him.”
As cynical as this strategy may be, it worked the last time around. Clinton’s failure to pass health reform is often cited as a major factor behind the Republican take over of the House in 1994. We’ll find out in November how well the strategy has worked this year.
Meanwhile, the non-partisan Kaiser Family Foundation has a great side-by-side comparison of the Affordable Care Act, the 1993 Republican proposal, and House Minority Leader, John Boehner’s (R-OH) health reform proposal. Check it out!
|Major Provisions||Senate Bill 2009||Sen. Chafee (R) Bill 1993||Rep. Boehner (R) Bill 2009|
|Require Individuals To Purchase Health Insurance
(Includes Religious and/or Hardship Exemption)
|Yes||Yes||No (individuals without
coverage would be taxed)
|Requires Employers To Offer Health Insurance To Employees||Yes (above 50 employees, must help pay for insurance costs to workers receiving tax credits
|Yes (but no requirement to contribute to premium cost)||No|
|Standard Benefits Package||Yes||Yes||No|
|Bans Denying Medical Coverage For Pre-existing Conditions||Yes||Yes||No (establishes high risk pools)|
|Establish State-based Exchanges/Purchasing Groups||Yes||Yes||No|
|Offers Subsidies For Low-Income People To Buy Insurance||Yes||Yes||No|
|Long Term Care Insurance||Yes (sets up a voluntary insurance plan)||Yes (sets standards for insurance)||No|
|Makes Efforts To Create More Efficient Health Care System||Yes||Yes||Yes|
|Reduces Growth In Medicare Spending||Yes||Yes||No|
|Medical Malpractice Reform||No||Yes||Yes|
|Controls High Cost Health Plans||Yes (taxes on plans over $8,500 for single coverage to $23,000 for family plan)||Yes (caps tax exemption for employer-sponsored plans)||No|
|Prohibits Insurance Company From Cancelling Coverage||Yes||Yes||Yes|
|Prohibits Insurers From Setting Lifetime Spending Caps||Yes||No||Yes|
|Equalize Tax Treatment For Insurance Of Self-Employed||No||Yes||No|
|Extends Coverage To Dependents||Yes (up to age 26)||No||Yes (up to age 25)|
|Cost||$871 billion over 10 years||No CBO estimate||$8 billion over 10 years|
|Impact On Deficit||Reduces by $132 billion over 10 years||No CBO estimate||Reduces by $68 billion over 10 years|
|Percentage Of Americans Covered||94% by 2019||92-94% by 2005||82% by 2019|