Earlier this week, Mitt Romney’s top campaign advisers broke with the entire Republican party and insisted that Obama’s health care mandate is “not a tax.” Then, on Wednesday, Romney contradicted his own campaign, saying in a CBS interview that “while I agreed with the dissent, that’s taken over by the fact that the majority of the Court said it is a tax, and therefore it is a tax.” Romney maintained in the same interview that while the Obamacare mandate is most definitely a tax, the Massachusetts health care mandate — which Romney instituted less than a decade ago and which is virtually identical to Obama’s mandate — “was a mandate, was a penalty, was described that way by the Legislature and by me, and so it stays as it was.”
Despite Romney’s public insistence that the Massachusetts health care mandate was not a tax, several official websites of the state explicitly call the mandate a “tax penalty.” The Official Website of the Office of Consumer Affairs & Business Regulation contains a page called “Massachusetts Health Care Reform: Tips and Resources,” which states that:
Starting July 1st, 2007, all Massachusetts residents age 18 and over must have health insurance. Every year, you will need to show proof of health insurance on your state income tax return. If you do not have health insurance, you will face a stiff tax penalty. For the 2007 tax year, this penalty is the loss of your personal exemption. In later years, it could be up to 50% of the amount of the cheapest health insurance plan offered through the Commonwealth Connector. If you need to buy health insurance, many new health plans are now available.
Another Massachusetts state website helps residents “estimate the tax penalties that you might face if you will be uninsured for part or all of 2011.”
The labeling of the mandate as a “tax penalty” on Massachusetts state websites only adds fuel to the debate of how best to characterize health care mandates. The websites, which are a primary resource for Massachusetts residents to navigate the state’s health care system, directly contradict Romney’s already confusing position on the mandate. Their characterization of the mandate as a “tax penalty” could pose a problem for Romney, who has criticized President Obama for breaking his pledge that he “wouldn’t raise taxes on middle-income Americans.”
Romney, however, disputes this in an interview with CBS. The National Journal has excerpts:
In agreeing with the Court that it constituted a tax and not a penalty, Romney could be vulnerable to criticism that the Massachusetts health care law he championed — which was the basis for Obama’s effort — also represented a tax. But Romney appears to be calculating that voters will care far more about the Court’s findings about the federal law than his state effort.
…In a portion of the interview released by Romney’s campaign, he insisted that a similar levy imposed on those who chose not to buy insurance by the Massachusetts healthcare law he signed as governor was not a tax.
“The chief justice, in his opinion, made it very clear that at the state level, states have the power to put in place mandates. They don’t need to require them to be called taxes in order for them to be constitutional. And as a result, Massachusetts’ mandate was a mandate, was a penalty, was described that way by the Legislature and by me, and so it stays as it was,” he said.
Thus, Romney’s current position appears to be that although his mandate in Massachusetts is the same as the Obamacare mandate, they should be called something different. It is hard to discern exactly why except, as the National Journal suggests, he percieves a political advantage in insisting on a difference where there is none.
Earlier this week, Mitt Romney’s top campaign adviser broke with the entire Republican party and insisted that the individual mandate at the center of the Affordable Care Act and Massachusetts’ 2006 health care law is “not a tax.” “The governor disagreed with the ruling of the Court. He agreed with the dissent, which was written by Justice Scalia, which very clearly stated that the mandate was not a tax,” Eric Fehrnstrom told MSNBC’s Chuck Todd.
But on Wednesday, in another sign that the Romney campaign doesn’t appear to speak for its candidate, Romney told CBS News that he agrees both with the Supreme Court’s dissent striking down the law and also its majority opinion upholding the mandate as a tax:
Q: Do you now believe that it is a tax at the federal level, that the Supreme Court has said it’s a tax, so it is a tax?
ROMNEY: Well, I said that I agreed with the dissent. And the dissent made it very clear that they felt it was unconstitutional. But the dissent lost — it’s in the minority. And so now the Supreme Court has spoken. And while I agreed with the dissent, that’s taken over by the fact that the majority of the Court said it is a tax, and therefore it is a tax. They have spoken. There is no way around that.
Republicans have seized on the Supreme Court’s decision to claim that the mandate is a “massive tax hike” on the middle class, labeling it the “largest tax increase in history.” But Romney — who instituted a similar requirement in Massachusetts — insisted as governor that the penalty is a way to discourage free-riders, though he has previously referred to the penalty as a “tax” penalty.
Romney shook hands as he marched in the Wolfeboro, N.H. Fourth of July parade and again agreed that the mandate is a tax:
Romney also tried to argue that while Obama’s mandate is a “tax” his own virtually identical provision is a penalty. “Actually the chief justice in his opinion made it very clear that at the state level, states have the power to put in place mandates,” Romney replied. “They don’t need to require them to be called taxes in order for them to be constitutional. And as a result, Massachusetts’ mandate was a mandate, was a penalty, was described that way by the legislature and by me, and so it stays as it was.” He has, however, previously described the Massachusetts mandate as a tax.
RNC Chairman Reince Priebus disagreed with his party’s presumptive presidential nominee during an appearance on CNN’s Starting Point Tuesday morning and said that the individual mandate at the heart of President Obama’s and Mitt Romney’s health care laws is, in fact, a tax. “The Supreme Court has stated that Obamacare is a tax and so since they have ruled that it’s a tax, it is a tax,” Priebus said, contradicting Romney’s top adviser, who on Monday insisted that the governor believes that the mandate is a penalty.
“Our position is the same as Mitt Romney’s position, it’s a tax, that’s the only way the Supreme Court came up with the decision it did, in order to make it constitutional,” the chairman claimed:
BROOKE BALDWIN (HOST): But it sounds like the Romney campaign says it was a penalty. I’m asking you specifically, Republican National Committee Chairman, tax or penalty, which is it?
PRIEBUS: It’s a tax and the reason why it’s a tax is because the Supreme Court number one ruled it was a tax and number two, it’s what Barack Obama’s lawyer argued before the Supreme Court.
Since Romney’s Massachusetts health reform law penalizes individuals who choose to go without insurance, the Romney campaign has said that the governor disagrees with the Supreme Court’s majority decision and agrees with the dissent, which found the mandate unconstitutional under the commerce clause. The mandate provision has successfully expanded coverage in Massachusetts by encouraging healthier and younger people to obtain insurance (who then avoid paying the penalty).
Republicans in Congress, and even some top Romney surrogates, however, are still holding on to the “tax” talking point. New Jersey Gov. Chris Christie (R), who may be on Romney’s vice presidential short list, told Fox News’ Fox & Friends Tuesday morning that the mandate is both a “penalty” and a “tax,” something Romney himself has previously claimed.
Last week, the Supreme Court ruled that the mandate in President Obama’s health care reform functions as a tax, making it constitutional under the federal government’s taxing power. Republicans and conservative media figures immediately jumped on this point, accusing the Obama administration of a massive tax hike. This puts Mitt Romney, the GOP’s presidential candidate, in an awkward spot. He signed precisely the same kind of mandate into law in a health care reform bill in Massachusetts, and his top campaign adviser Eric Fehrnstrom has explicitly insisted that mandate was not a tax.
Last week, conservatives responded to the Supreme Court’s ruling upholding the constitutionality of the Affordable Care Act by issuing flamboyant denunciations of the the justices and the court. Glenn Beck labeled Chief Justice John Roberts a “coward,” a New Hampshire Tea Party leader said he hopes the justices in the majority contract cancer, and prominent GOP-aligned websites claimed that Roberts’ epilepsy medication drove him to endorse the individual requirement.
But Fox News’ resident psychiatrist Dr. Keith Ablow may win the prize for the most outrageous reaction. In a column posted on FoxNews.com and during an interview Monday afternoon on the network, Ablow claimed that the court’s decision will “iInfantilize” Americans:
ABLOW: [T]oday it could be healthcare, tomorrow it could be a hybrid vehicle that you are penalized financially for not buying. It takes control of your behavior in the way that a parent would of a child, and it diminishes us in terms of our autonomy and ability to achieve things even for liberty on the world stage, quite literally.
MEGYN KELLY (HOST): You say it’s making Americans believe that they are weak. How?
ABLOW: It absolutely infantilizes Americans, because listen, even adolescents or younger kids, they dream of the day when they are in charge of their own money…. What it does is deposits us back as children, when economically more than ever we need to be adults.
Ablow went on to argue that requiring people to take personal responsibility for their own health care spending “can make citizens see themselves as serfs who actually have no right at all to the money they earn, and keep it only when it suits the federal government.” “With Egypt in the hands of the Muslim Brotherhood, with Iran building nuclear weapons and with Europe facing economic calamity, the last thing we need are lessons from Washington in how to be weak individuals,” he warned.
Mitt Romney campaign adviser Eric Fehrnstrom said the governor disagrees with Republicans’ claim that the individual mandate is a “tax,” contradicting the party message since the Supreme Court ruled that Congress had authority to mandate people purchase insurance under the taxing power.
“The governor disagreed with the ruling of the Court,” Fehrnstrom said, “he agreed with the dissent, which was written by Justice Scalia, which very clearly stated that the mandate was not a tax”:
TODD: The governor does not believe the mandate is a tax — that’s what you’re saying?
FEHRNSTROM: The governor believes what we put in place in Massachusetts was a penalty and he disagrees with the Court’s ruling that the mandate was a tax. [...]
TODD: But he agrees with the president that it is not — and he believes that you should not call the tax penalty a tax, you should call it a penalty or a fee or a fine?
FEHRNSTROM: That’s correct. But the president also needs to be held accountable for his contradictory statements. He has described it variously as a penalty and as a tax. He needs to reconcile those two very different statements.
Republicans have seized on the Supreme Court’s decision to claim that the mandate is a “massive tax hike” on the middle class, labeling it the “largest tax increase in history.” But Romney — who instituted a similar requirement in Massachusetts — insisted as governor that the penalty is a way to discourage free-riders and is not a new tax on families.
Greg Sargent notes that Romney himself has referred to the penalty as a “tax” penalty.
The Romney campaign doubles down:
Romney spox @AMHenneberg on campaign’s official position: “Gov. Romney thinks it is an unconstitutional penalty”
It might be time for Republicans to take a look back at their own record of health care legislation that they did like — and that forced American people, particularly women, into a lot of things:
Forcing women to get transvaginal ultrasounds: Virginia Gov. Bob McDonnell wanted to force every woman seeking an abortion to go through the extremely uncomfortable and medically unnecessary procedure of a transvaginal ultrasound — sticking a medical wand far into a woman’s vagina to get a clearer ultrasound image.
Ordering women to cremate and bury their miscarried fetus: A huge abortion omnibus bill in Michigan could force women who miscarry to cremate the miscarried fetuses. This comes at no small expense to the woman: cremation of a fetus costs hundreds of dollars, and interment can be additional thousands. The bill has been passed by the Michigan House, and is awaiting a vote by the Michigan Senate.
Requiring doctors to lie to female patients: In Kansas, Republicans tried to force doctors to tell women that they faced risk of cancer from having an abortion. That is patently untrue, and making doctors say that it was true would be, in effect, requiring them to lie to their patients.
Making a dying woman consult two doctors before she can get a life-saving abortion: The New Hampshire legislature just overrode a veto by the Governor, forcing through a law that bans “partial birth” abortions. The law only reinforces federal law, but has the additional requirement that any woman who is exempt from the abortion ban because her life is at risk must visit not one but two doctors before she can get the procedure to save her life. For many rural women, especially those facing life-threatening conditions, this is near impossible.
Mandating people pay extra to give medical device companies a tax break: Rep. Erik Paulsen (R-MN) worked so hard to protect medical device companies from having to pay, that he has instead passed their costs onto the consumer — regular Americans — by increasing the cost of health coverage.
Republicans are responding to the Supreme Court’s ruling upholding the individual mandate by constructing a new “death panels”-like lie. The law, they argue, imposes a burdensome tax on millions of middle class families who will have to pay a penalty for not purchasing health care coverage by 2014. The line originates in the majority’s decision, which found that Congress has the authority to require individuals to buy coverage under its taxing power, but it doesn’t mean what the Republicans are suggesting.
The truth is that the penalty for not buying insurance — $695 or 2.5 percent of household income — is well in line with other policies that are designed to encourage and promote a particular kind of economic behavior. On Friday morning, NBC’s Chuck Todd compared the penalty to a speeding ticket and asked House Majority Leader Eric Cantor (R-VA) to distinguish between the two taxes. Cantor could not:
TODD: On the tax front quickly, is a speeding ticket a tax? By that same definition? You can avoid paying this tax if you get insurance. [...]
CANTOR: First of all, let me — I can’t respond to whether the speeding ticket would be considered a tax or not under the states’ authority any states’ authority. What I can tell you is the court came down on this issue decided that it was a tax to coerce some type of behavior.
In the case of health care, the law is offering an incentive for younger and healthier Americans to purchase health insurance coverage before they fall ill and pass on the costs of their treatments on to the government and other premium payers. Widespread take-up of coverage could cut government expenditures on uncompensated care in half. As Mitt Romney explained in 2006, “I don’t think the free market ever envisioned an idea that people would be able to do something and make other people pay for it.” And after successful implementation of reform in Massachusetts, few are.
On the federal level, the Congressional Budget Office is projecting that 30 million Americans will enroll in insurance as a result of the law, millions more will receive a tax cut to help them afford coverage, and of the remaining uninsured, “the majority of them will not be subject to the penalty“:
21 million nonelderly residents will be uninsured in 2016, but the majority of them will not be subject to the penalty. Unauthorized immigrants, for example, are exempted from the mandate to obtain health insurance. Others will be subject to the mandate but exempted from the penalty—for example, because they will have income low enough that they are not required to file an income tax return, because they are members of Indian tribes, or because the premium they would have to pay would exceed a specified share of their income (initially 8 percent in 2014 and indexed over time). CBO and JCT estimate that between 13 million and 14 million of the uninsured in 2016 will qualify for one or more of those exemptions. Of the remaining 7 million to 8 million uninsured, some individuals will be granted exemptions from the penalty because of hardship, and others will be exempted from the mandate on the basis of their religious beliefs. [...]
After accounting for all of those factors, CBO and JCT estimate that about 4 million people will pay a penalty because they will be uninsured in 2016 (a figure that includes uninsured dependents who have the penalty paid on their behalf).
Real world experience suggests that Americans are more likely to purchase insurance than pay the penalty for going without coverage. For instance, in Massachusetts, the only state with an insurance mandate, less than 1 percent of the state’s residents paid the penalty in 2009. Surveys of the uninsured have also found that an overwhelming majority — 76 percent of the uninsured — would rather comply with the individual mandate in the Affordable Care Act and purchase insurance than pay the far less onerous penalty for forgoing it. Experts believe that “health insurance mandates differ from some other requirements, such as the requirement to pay taxes” because “enrollees individually receive a tangible good–health insurance—that they value.”
During a press conference call this afternoon, MIT economist Jonathan Gruber — who advised both Mitt Romney and Barack Obama on health care — stressed that less than 1 percent of (or 44,000 out of 6 million) Massachusetts residents are paying the penalty for not enrolling in health insurance. That fee helps the state fund the uncompensated care of people who become sick but don’t have personal insurance. Since Romneycare went into effect, “annual state spending for uncompensated care dropped by $118 million over the first five years of reform.”