While the final health care reform law probably resembles the GOP’s 1993 health care plan closer than some of the more progressive alternatives Democrats proposed during the 2008 Presidential election, Republicans and their conservative allies have gone to great lengths to portray reform as a radical government takeover of health care. Organizations like the Heritage Foundation and politicians like Mitt Romney and Chuck Grassley, who have historically supported centrist reform provisions like the individual mandate, state-based exchanges and tax credits to help Americans purchase affordable coverage, are now abandoning their old positions and aligning themselves with conservatives who argue that health reform is unconstitutional. The shift is part of an election strategy designed to convince Americans that the new health care law is a left-wing to expand government control over the health care system.
President Obama, however, has repeatedly credited Heritage and Romney for providing the foundation for several reform provisions, placing some conservatives on the defensive. Just today, Robert Moffit of the Heritage Foundation attempted to distance his organization from national reform:
First, Heritage did not originate the concept of the health insurance exchange. Furthermore, the version of the exchange we did develop couldn’t be more different than that embodied in this law. For us, the health insurance exchange is to be designed by the states. It is conceived as a market mechanism that allows individuals and families to choose among a wide range of health plans and benefit options for those best suited to their personal needs and circumstances. People would have a property right in their health policy, just like auto or homeowners’ policies, and be able to take it with them from job to job. Under the Heritage design, individuals could choose the health plan they want without losing the tax benefits of employer-sponsored coverage. The exchange we propose would be open to all state residents and — very importantly — be free of federal regulation. [...]
For the record, we think that the law’s federal mandate is unconstitutional. Our legal center, led by former attorney general Edwin Meese III, notes that Congress has no authority to force an American to buy any good or service merely as a requirement of being alive.
Yes, in the early 1990s, we, along with other prominent conservative economists, supported the idea of such a mandate. It seemed the only way to solve the “free-rider” problem, in which individuals can, under federal law, walk into any hospital emergency room nationwide and rack up big bills at taxpayer expense.
Two things. First, it’s true that the exchanges and the individual mandate in the final health care law are different than Heritage would have liked, but that, after all is the nature of the political process. The final legislation is a collection of conservative and progressive ideas (more the former and the latter) and one can’t argue that modifying a conservative ideas renders it completely unrecognizable. The new health care law requires each state to establish its own exchange and gives states a great deal of flexibility in running, operating and regulating the new health insurance markets.
Second, Moffit’s claim that Heritage foolishly supported the individual mandate when it was part of a fad in the 1990s is just inaccurate. As Lee Fang points out, Heritage boosted Romney’s health reform plan as recently as 4 years ago, calling the individual mandate “Not an unreasonable position, and one that is clearly consistent with conservative values.”
The fact is, conservatives openly acknowledged the bipartisan nature of health care reform throughout 2009 and are now backing away from the law for purely political purposes. In September 2009, for instance, Rep. Eric Cantor (R-VA) told a town hall meeting that “Republicans and Democrats agree on 80 percent of fixing the nation’s healthcare system.” Rep.Charles Boustany (R-LA), who delivered the Republican response to the President’s congressional address in September, also said, “I would venture to say that we agree on about 80% of the issues right now. It’s just a matter of hashing out those few areas where we disagree, but there’s really not been that kind of real discussion, and it needs to happen.”