As the constitutionality of Obamacare is examined this week by the highest court in the land, increased scrutiny has come under President Obama's support of the most controversial provision of the healthcare reform bill: the "individual mandate" that requires individuals to have health insurance by 2014 or pay a penalty.
And now, an internal Obama administration memo sheds light on how Obama went from trashing the mandate during the campaign to embracing it as a cornerstone of the controversial legislation.
As we mentioned on Monday, the group American Crossroads released a web video illuminating Obama's on-and-off support for the mandate. During the 2008 Democratic presidential primary campaign, strong support of the individual mandate was one of the few issues separating Hillary Clinton from Barack Obama. Obama pounded Clinton for her mandate proposal in ads leading up to the pivotal Pennsylvania Democratic primary, telling voters "It forces everyone to buy insurance, even if you can't afford it, and you pay a penalty if you don't."
Buzzfeed's Andrew Kaczynski assembled a highlight reel in January revealing the extent of Obama's criticisms of the mandate during the 2008 campaign:
But when Obama entered the oval office and saw resistance towards his health care plan from Democrats in both the House and Senate the president began to change his tune. In search of where the flip-flop first occurred, The New Yorker published yesterday a seven-page April 2009 memo to President Obama from his top healthcare adviser Nancy-Ann DeParle:
The entire memo is worth reading—it reveals, among other things, that the Administration’s early estimate for its plan was $1.4 trillion and that it debated partially paying for health care with “a 10-cent excise tax on sugar-sweetened beverages”—but of particular interest are passages that include one of the earliest discussions with the President about how he would have to reverse the position he took during the campaign.
DeParle begins by summarizing for Obama the status of legislation in Congress. She notes that Democrats in both chambers are pro-mandate, meaning that Obama’s campaign position now makes him an outlier in the debate. Perhaps to nudge him in the mandate direction, she also reminds him that late in the campaign he started to make some pro-mandate noises.
Later in the document, there are two more notable items. One is that DeParle does not frame the case for the mandate strictly on the merits of the idea. Instead, she points out—somewhat grudgingly—that Obama would almost have to reverse his campaign position because of the way the Congressional Budget Office would treat a health-care bill without an individual mandate. [Emphasis added]
To sell the individual mandate to middle-class families, the memo reveals that DeParle went on to nudge the president to look to the plan in Massachusetts, AKA "Romneycare." The New Yorker closes by acknowledging a July 2009 CBS interview, three months after the DeParle memo, where the president states his new position on the individual requirement to have health insurance.
“I have come to that conclusion,” Obama said to CBS. “During the campaign I was opposed to this idea because my general attitude was the reason people don’t have health insurance is not because they don’t want it, it’s because they can’t afford it. And if you make it affordable, then they’ll come. I am now in favor of some sort of individual mandate as long as there’s a hardship exemption.”
In 2012, the individual mandate is at the heart of public resistance to Obamacare. A Gallup survey in February revealed that Americans, by an overwhelming margin of 52 percent, believe the mandate is unconstitutional.
You can read a draft of the memo here.
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