The conservative Heritage Foundation is very, very upset that the Obama Administration pointed out their many, many years of support for a requirement that all Americans carry health insurance in a brief defending the Affordable Care Act. So upset, it turns out, that they filed an amicus brief informing the court that they have completely flip-flopped on their longstanding support for such a requirement:
Yesterday, The Heritage Foundation filed a friend-of-the-court brief with the 11th Circuit U.S. Court of Appeals, reiterating Heritage’s opposition to the individual mandate that is a key piece of the Obamacare statute. This is the first time we have ever filed such a brief—as far anyone around here can remember. But we had no other choice. In its merits brief before the appeals court, the U.S. government quoted a 21-year-old statement by a Heritage Foundation policy expert supporting an individual mandate for health insurance, when Heritage’s view today is to the contrary. . . .
For a research organization such as ours to be intellectually honest, we cannot rigidly accept an idea presented decades ago, and ignore empirical evidence presented since. That is why we changed our position on individual mandates long before President Obama ever spoke of one.
Heritage was one of the earliest champions of a minimum coverage requirement like the one in the Affordable Care Act — endorsing this proposal as early as 1989. One of their vice presidents testified in support of this requirement as recently as 2003. The earliest example Heritage cites in its brief of them reversing their longstanding position on health reform is a 2008 article published after Democratic presidential candidate Hillary Clinton had prominently endorsed Heritage’s previous stance.
Moreover, Heritage’s claim that they flip-flopped because of “empirical evidence” is difficult to believe. Their brief lists five reasons why they suddenly stopped believing in an minimum coverage requirement after that position was endorsed by a leading Democrat, but many of them are nothing more than platitudes such as “[o]n philosophical grounds, policymakers should retain a bias for personal liberty.” The only empirical study they cite explaining their position is a mostly irrelevant study showing that more people will participate in 401k programs if they are automatically enrolled in them.
If Heritage actually believes that this study has implications for health insurance policy, however, then they have no business providing advice to federal judges. The reason why an insurance coverage requirement is necessary is to prevent something known as “adverse selection.” The ACA prohibits insurance companies from denying coverage to persons with preexisting conditions, but this ban cannot function if patients are free to enter and exit the insurance market at will. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, leaving nothing left for the rest of the plan’s consumers.
In other words, people who wait until the last minute to buy health insurance force other people to pick up the costs of their care. People who wait until the last minute to plan for their retirement, by contrast, bear the cost of their own irresponsibility upon their own shoulders. Accordingly, Americans have far fewer incentives to delay planning for retirement than they do to delay buying health insurance, and thus are more likely to change their behavior because of a gentle “nudge” such as an automatic enrollment program.
Sadly, Heritage’s embarrassing defense of its politically expedient flip-flop is emblematic of their shoddy policy research. Last month, Rep. Paul Ryan (R-WI) relied on a Heritage Foundation analysis to claim that his Medicare-eliminating budget would produce shocking low unemployment and equally unbelievable economic growth. After the Center for American Progress pointed out that Heritage’s projections “are not just overly optimistic, they are impossibly optimistic,” Heritage was forced to print a correction indicating that they had made a basic math error that led to their impossible claim that Ryan’s draconian budget would cause unemployment to drop to 2.8 percent.
