Wednesday, June 01, 2011

Learning to love the individual mandate

A pivotal moment in Boston Globe reporter Brian C. Mooney's in-depth retrospective on Mitt Romney's role in passing healthcare reform in Massachusetts centers on a qualified acceptance of the plan's most politically fraught element:
“I’ve never been one for individual mandates in the past, but I do think that the way this has been proposed, in that everybody will do their part, that’s a compromise...I can buy into that.’’
That's Ted Kennedy speaking.  Romney's commitment to the mandate came earlier (it was Romney's plan that Kennedy responded to above) and was much less guarded when it came.  The mandate was far more in accord with Romney's principles (at that point in his career it still appeared that he had some) and with the interests of his support base than it was with Kennedy's. 

On the philosophical front, Romney told reporters when he first introduced the plan, "No more free riding, if you will, where an individual says: ‘I’m not going to pay, even though I can afford it.’ … It’s the ultimate conservative idea, which is that people … don’t look to government to take care of them if they can afford to take care of themselves.’’ 

What's more interesting in Mooney's account, though, is the individual mandate's apparent role in making universal healthcare that relies chiefly on employer-provided insurance palatable to the business community.  Mooney recalls that Michael Dukakis' bid to expand coverage was strangled in the crib (passed, but never enacted and eventually repealed) because it hinged on a " proposed penalty of up to $1,680 per employee on companies that did not offer insurance."  Romney put together a public-private team focused on winning buy-in from the business community:
Mindful of the errors of the Dukakis reform drive in 1988, the Partners-Blue Cross alliance was determined to create a united front within the state’s business community.

Connors enlisted a quartet of key business players he dubbed “the four horsemen,’’ after the famed Notre Dame football backfield of the 1920s.

They were leaders of associations that represented the largest employers in Massachusetts. All had experience in government and navigating the intersection of politics and policy in health care. Their members were generally supportive of expanded coverage as good business practice and a quality-of-life issue.

But all also opposed any mandate on their business members to provide insurance.

Murphy, head of the reshuffled Romney team, had been a vice president of a Wall Street investment banking firm and before that served on the staff of the Senate Ways and Means Committee. He understood complicated financial issues and knew the ways of the State House. His task was to craft a more market-oriented solution that would expand coverage without requiring new taxes.
In end-game negotiations, the employer mandate was whittled down to a "'fair share contribution'’ of $295 per employee from businesses with 11 or more employees that did not offer coverage."  Still it was that tax, not the individual mandate, that was politically toxic to business-friendly Romney.  While signing the bill with great fanfare, he vetoed the section with the mandate, knowing the veto would be over-ridden. Win-win, as Mooney explains: "He could claim a large share of credit for the new law while washing his hands of something resembling a tax, problematic with a national Republican audience."

When Congressional Democrats and Obama put together the legislation that became the Affordable Care Act, it was the individual mandate, along with healthcare exchanges composed of private insurers, that drove Nancy Pelosi to say, with apparent absurdity but historic truth on her side,  “The bill can be bipartisan, even though the votes might not be bipartisan, because they [Republicans] have made their imprint on this." None more so than Romney, who first brought the mandate and the exchanges to life.

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