As the Supreme Court debates the constitutionality of the individual mandate, a newly released internal White House memo shows that the success of Massachusetts’ mandate may have helped convince President Obama to adopt the strategy on the national level.
As the New Yorker’s Ryan Lizza, who obtained the memos, notes, “one of the few significant policy disagreements” between Obama and Hillary Clinton during the 2008 primary campaign “was whether or not to include such a mandate in a health-care plan.” Clinton supported it, Obama initially opposed it. But after hearing from his advisers, Obama changed his mind, concluding that the mandate was necessary.
An April, 2009 briefing memo from senior White House health policy adviser Nancy-Ann DeParle lays out “a set of savings and revenue options” for health care, including the mandate. Under a section called “Individual Requirement for Health Insurance,” DeParle makes the case for the mandate by citing the Massachusetts law passed by former governor Mitt Romney as a positive example:
Because of concerns about the impact of the individual requirement on middle income families, we have explored coupling an individual requirement with an exemption process for those for whom coverage remains unaffordable. In Massachusetts, taxpayers are exempt from the mandate-associated penalties if the lowest premiums available to them exceed a certain fraction of income (for example at $60,000 of family income, families are excused from penalties if premiums exceed $4,400 — about 7 percent of income). There is an additional waiver process that allows people to claim a hardship exemption from the penalty on a case-by-case basis if they have special circumstances.
This is the only time any state is mentioned in the seven page memo.
Meanwhile, it’s already known that senior White House officials — including Obama himself — had a dozen meetings in 2009 with three health experts who helped shape Romney’s law. “They really wanted to know how we can take that same approach we used in Massachusetts and turn that into a national model,” said MIT economist Jon Gruber of a July meeting.
Romney’s health care law has become a major campaign issue, with challenger Rick Santorum rallying in front of the Supreme Court today to say that he is the only candidate in the GOP presidential primary who can draw a contrast with Obama on this issue, because Obama’s law is based on Romney’s.