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The GOP’s “Obamacare” problem

The recent Republican presidential debate in New Hampshire featured what is by now a familiar ritual– all of the GOP candidates fighting to prove that they are the one most against “Obamacare.”

But we wondered– do all the top GOP contenders really hate health care reform that much or was this just political posturing? So we looked into what they’ve said and voted for in the past. Turns out that nearly all of them have supported the same policies that they’re now attacking.

Mitt Romney

Last month, the Wall Street Journal published an editorial on Mitt Romney’s “Obamacare problem.” Romney’s “problem” is that the Affordable Care Act looks awfully similar to the health reform Massachusetts enacted while Mitt Romney was governor:

  • both use insurance exchanges,
  • both subsidize coverage for people who can’t afford it,
  • both eliminate discrimination based on pre-existing conditions, and
  • both have an individual mandate to prevent freeloaders.

Since Republicans have decided that the individual mandate is now evil, the WSJ called Romney “compromised and not credible,” adding, “If he does not change his message, he might as well try to knock off Joe Biden and get on the Obama ticket.” Ouch. (Also, we’d like point out that the satirical newspaper, The Onion, scooped the WSJ back in April, with an article titled, Mitt Romney Haunted by Past of Trying to Help Unnisured Sick People.)

Romney’s been left in a tough spot– (1) forced to defend his own approach to health reform, while (2) still attacking “Obamacare.” He’s done the first part fairly well. For example, in a recent talk at the University of Michigan, he did a better job defending the individual mandate than most Democrats. However, when he tries to point out differences between Massachusetts’ reform and President Obama’s, things start to get silly.

Here are the points he made in the debate:

  1. “Obamacare spends a trillion dollars. If it were perfect– and it’s not perfect, it’s terrible– we can’t afford more federal spending.” Romney fails to mention that while “Obamacare” will cost $900 billion over the next decade (to cover 32 million people by the way), it’s more than paid for– the CBO estimates it will reduce the deficit by $230 billion in the next ten years, and possibly more after that.
  2. “It raises $500 billion in taxes. We didn’t raise taxes in Massachusetts.” Really, the only people who will see their taxes go up are the very wealthy and people with so-called “cadillac” insurance plans. Also, there’s a reason Massachusetts didn’t have to raise taxes to pay for reform– the federal government paid for it.
  3. “Obamacare takes $500 billion out of Medicare and funds Obamacare. We of course didn’t do that.” For what seems like the thousandth time, we’d like to point out that much of the savings comes from simply bringing Medicare Advantage (a program where private insurance companies handle some seniors’ coverage) spending in line with the rest of Medicare– right now Medicare Advantage costs the government 19% more than traditional Medicare. Other savings comes from smaller increases in payments to certain providers. And Paul Ryan’s budget proposal (which nearly every Republican in Congress voted for) contains nearly all the same reductions in spending that Republicans have criticized in the ACA.
  4. “Ours was a state plan, a state solution, and if people don’t like it in our state, they can change it. That’s the nature of why states are the right place for this type of responsibility.” The Affordable Care Act, again as we’ve explained before, does allow states to implement their own solutions to health reform– just as long as their plans cover as many people and don’t cost more than the ACA. It sets a minimum standard- but if states think they can do better, there’s nothing stopping them.

Newt Gingrich

Gingrich has probably done the biggest 180 on the mandate. Here’s what he said in Monday’s debate:

“If you explore the mandate, which even the Heritage Foundation at one time looked at, the fact is when you get into a mandate it not only ends up with unconstitutional powers, it allows the government to define virtually everything, and if you can do it for health care, you can do it for everything in your life, and therefore we should not have a mandate.”

And here’s Newt Gingrich in 1993:

“I am for people, individuals — exactly like automobile insurance — individuals having health insurance and being required to have health insurance. And I am prepared to vote for a voucher system which will give individuals, on a sliding scale, a government subsidy so we insure that everyone as individuals have health insurance.”

This wasn’t an isolated incident– Gingrich has long been a vocal champion of the individual mandate, and has yet to explain why he changed his mind about it the day after David Gregory asked him about his earlier statements.

One more thing–Gingrich’s says that the conservative Heritage Foundation found the individual mandate unconstitutional. We’ve talked about this before, but it’s worth pointing out again that Heritage had a very different take on the mandate when Romney passed it in Massachusetts. 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]

Jon Huntsman

Former Utah Governor Jon Huntsman only recently announced his candidacy, but he’s been laying the groundwork for months. Part of that, of course, means denying any past support for the individual mandate.

He’s quick to point out that Utah’s health plan, which he signed into law in 2008, doesn’t include one.  “I didn’t push mandates with the legislature. You want to get that right,” he told reporters in New Hampshire recently.

But Huffington Post reports that Dr. David Sundwall, who was director of Utah’s Department of Health under Huntsman and Judi Hilman, executive director of the nonpartisan Utah Health Policy Project, tell a different story. They say that Huntsman was supportive of the individual mandate, but dropped it when it was rejected by Utah’s legislature.

Oh, and here’s Huntsman in 2007:

HUNTSMAN: I’m comfortable with a requirement [to have coverage]. You can call it what you want, but at some point, we’re going to have to get serious about how we deal with this issue. And that means there will have to be a multitude of different policies that are available in the market place. It means that it will be incumbent upon citizens to look at responsibility, their own responsibility in terms of health and the choices that are made…. There is a mandate today, let’s not forget, it’s called the emergency room…. We’re living today in an environment, to be sure, where there’s a mandate in place. It’s whether you really want to make the system more efficient.”

Tim Pawlenty

Pawlenty in Monday’s debate:

“In order to prosecute the case against President Obama you have to be able to show you’ve got a better plan and a different plan. We took a different approach in Minnesota. We didn’t use top down government mandates and individual requirements from government, we created market alternatives and empowered consumers. I think that that’s the way to fix health care in the United States of America.”

It’s true that Pawlenty never pushed for an individual mandate in Minnesota, but he did explore it as a possibility. Here’s what he said at a press conference in 2007:

“In Minnesota as to the access issue, I believe we should move towards universal coverage. Everybody should be in a health plan of some sort. How we get there becomes important, I think a mandate by itself is potentially helpful, but is not an answer by itself.”

In another speech he called the requirement to buy insurance “a worthy goal and one that we’re intrigued by and I think at least open to.” And the website Politco explains that he did push for another key element of Obama’s health plan – an insurance exchange – an idea he now says interferes with the free market.

Also, looking at the comprehensive health bill Pawlenty signed in 2008, one notices an awful lot of similarities to the Affordable Care Act. That bill, SF3780:

  • Expanded MinnesotaCare (Minnesota’s Medicaid program) eligibility for childless adults to 250 percent of the federal poverty level
  • Reduced the sliding scale premiums for MinnesotaCare
  • Mandated that employers with 11 or more employees that didn’t offer insurance, offer a Section 125 plan (basically a plan where employees could pay for premiums with part of their paycheck before it was taxed)
  • Provided funding and support to public health programs to reduce smoking and obesity;
  • Promotes the use of health care homes to coordinate care for people with chronic conditions
  • Improves health information technology, including electronic medical records and e-prescriptions.
  • Create work groups to explore provider payment reform, and implement other cost-containment strategies.

The Affordable Care Act meanwhile:

  • Expands Medicaid eligibility to 133% of the federal poverty level
  • Helps pay for premiums on a sliding scale to help people purchase private insurance
  • Mandates that employers with 50 or more employees provide insurance or pay a tax penalty
  • Provided funding and support to public health programs to reduce smoking and obesity;
  • Promotes the use of health care homes to coordinate care for people with chronic conditions
  • Improves health information technology, including electronic medical records and eprescriptions.
  • Creates pilot programs to explore provider payment reform, and implement other cost-containment strategies.

Donald Trump

Trump recently announced that he won’t be running for president, but we’re including him anyways since (1) it’s Trump so you never know, and (2) his position on health care is way to the left of even the Affordable Care Act. Slate points out that in his book, The America We Deserve, Trump supported a Canadian-style, single-payer health care system:

“We must have universal healthcare,” wrote Trump. “I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses.”

The goal of health care reform, wrote Trump, should be a system that looks a lot like Canada. “Doctors might be paid less than they are now, as is the case in Canada, but they would be able to treat more patients because of the reduction in their paperwork,” he writes.

Mitch Daniels

Indiana Governor Mitch Daniels has already declared that he won’t run in 2012, but he was considered a possible front-runner. He too pushed an individual mandate and expanding Medicaid in his state.

Michelle Bachmann

Michelle Bachmann and other tea-party-backed candidates built a following largely based on their opposition to “Obamacare,” but Bachmann’s recent comments indicate that they might just be incredibly misinformed.

Last week at the Republican Leadership Conference she said:

“I think very likely what the president intends is that Medicare will go broke, and ultimately that answer will be Obamacare for senior citizens.

Just when our population of senior citizens is growing with baby boomers joining their ranks, we’ll have more people but less money, and no plan to save it”

It’s a bizarre statement, since here’s “Obamacare” in a nutshell:

  • creates a system where people without insurance can purchase private insurance, and the government helps to pay the premiums of those who can’t afford coverage.

And Bachmann voted for Paul Ryan’s budget which would:

  • turn Medicare into a system where seniors purchase private insurance, and the government helps to pay the premiums of those who can’t afford coverage.

Ryan’s budget also keeps the $500 billion in reduced Medicare spending from the Affordable Care Act, in addition to his own new massive reductions in funding that would leave the average senior paying 40% more in health care costs in 2022. Democrats opposed Ryan’s budget because, while insurance exchanges and premium support are a better option for people with no coverage now, they’re not a better option for seniors covered by Medicare.

So… who wants to turn Medicare into “Obamacare” again? We’re not sure which scenario is worse: that Bachmann has no idea what’s actually in the Affordable Care Act and Paul Ryan’s budget, OR she does know and is simply lying.

Ron Paul

Possibly the one Republican candidate who has held elected office (Herman Cain is CEO of a pizza company) who can plausibly say that he’s never supported policies in the Affordable Care Act. However, people like him and Michelle Bachmann are usually considered extremists (for example, not only does Paul want to repeal the Affordable Care Act, he wants to eliminate the Department of Health and Human Services, and has indicated in the past he would abolish Medicare and Medicaid).

What happened?

In 2009, one of two things happened. It’s possible that every Republican now running for President simultaneously came to the conclusion that policies they used to support– like an individual mandate and insurance exchanges– were the greatest assault on freedom since the cold war.

The other, perhaps more likely explanation, is that Republicans made a political calculation to use health reform to go after Obama, opposing whatever he proposed. (Republican Senator Jim Demint hinted at this strategy when he said that health reform would be Obama’s “Waterloo,” adding, “It will break him.”) Instead of moving the party’s extremists towards Obama’s moderate proposal, they moved towards the extremists. Then they started attacking their old positions as a “government takeover of healthcare.”

UPDATE: Time Magazine’s Kate Pickert has more on Jon Huntsman’s and Tim Pawlenty’s past support of health care policies they now claim to oppose.

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