a little history lesson here..... The Patient Protection and Affordable Care Act consists of a combination of measures to control healthcare costs, and an expansion of coverage through public and private insurance: broader Medicaid eligibility and Medicare coverage, and subsidized, regulated private insurance. An individual mandate coupled with subsidies for private insurance as a means for universal healthcare was considered the best way to win the support of the Senate because it had been included in prior bipartisan reform proposals. The idea goes back as far as 1989, when it was initially proposed by the conservative Heritage Foundation as an alternative to single-payer health care.[50] It was championed by many Republican politicians as a market-based approach to healthcare reform on the basis of individual responsibility. Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (which nearly all do) to provide emergency care to anyone who needs it, the government often indirectly bore the cost of those without the ability to pay.[51][52][53] When, in 1993, President Bill Clinton proposed a healthcare reform bill that included a mandate for employers to provide health insurance to all employees through a regulated marketplace of health maintenance organizations, Republican Senators proposed an alternative that would have required individuals, but not employers, to buy insurance.[52] Ultimately the Clinton plan failed due to concerns that it was overly complex, amid an unprecedented barrage of negative advertising funded by politically conservative groups and the health insurance industry.[54] After failing to obtain a comprehensive reform of the healthcare system, Clinton negotiated a compromise with the 105th Congress to instead enact the State Childrens Health Insurance Program (SCHIP) in 1997.[55] The 1993 Republican alternative, introduced by Senator John Chafee as the Health Equity and Access Reform Today Act, contained a universal coverage requirement with a penalty for noncompliance—an individual mandate—as well as subsidies to be used in state-based purchasing groups.[56] Advocates for the 1993 bill included prominent Republicans who today oppose a mandate, such as Senators Orrin Hatch, Chuck Grassley, Bob Bennett, and Kit Bond.[57][58] Of the 43 Republicans Senators from 1993, almost half—20 out of 43—supported the HEART Act.[50][59] Another Republican proposal, introduced in 1994 by Senator Don Nickles, the Consumer Choice Health Security Act, also contained an individual mandate with a penalty provision;[60] however, Nickles subsequently removed the mandate from the bill, stating he had decided that government should not compel people to buy health insurance.[61] At the time of these proposals, Republicans did not raise constitutional issues with the mandate; Mark Pauly, who helped develop a proposal that included an individual mandate for George H.W. Bush, remarked, I don’t remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax.[50] An individual health insurance mandate and an insurance exchange was also enacted at the state level in Massachusetts: In 2006, Republican Governor Mitt Romney signed an insurance expansion bill with strong bipartisan support, including that of Senator Ted Kennedy. Romneys successful implementation of the Health Connector exchange and individual mandate in Massachusetts was at first lauded by Republicans. During Romneys 2008 presidential campaign, Senator Jim DeMint praised Romneys ability to take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured. Romney himself said of the individual mandate: Im proud of what weve done. If Massachusetts succeeds in implementing it, then that will be the model for the nation.[62] In 2007, a year after the Massachusetts reform, Republican Senator Bob Bennett and Democratic Senator Ron Wyden introduced the Healthy Americans Act, which also featured an individual mandate and state-based regulated insurance markets called State Health Help Agencies.[53][62] The bill attracted bipartisan support but died in committee; however, many of the sponsors and co-sponsors remained in Congress during the 2008 healthcare debate.[63] Given the history of bipartisan support for an individual mandate and regulated insurance markets with subsidies as well as their perceived success in Massachusetts, by 2008 Democrats were considering using this approach as the basis for comprehensive, national healthcare reform. Experts have pointed out that the legislation that eventually emerged from Congress in 2009 and 2010 bears many similarities to the 2007 bill[56] and that it was deliberately patterned after Romneys state healthcare plan.[64] Jonathan Gruber, a key architect of the Massachusetts reform who advised the Clinton and Obama presidential campaigns on their healthcare proposals, served as a technical consultant to the Obama administration and helped Congress draft the ACA
Posted on: Tue, 22 Oct 2013 03:20:49 +0000
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