The Real Reason Republicans hate "Obamacare"
Answer number 1: Republicans don’t actually hate Obamacare.
There are several real answers to this question. The first answer is
that Republicans don’t hate Obamacare, unless you call it Obamacare.
As recently noted by Joan McCarter (link),
if you list the various attributes of the Affordable Care Act one by
one, Americans, including Republicans actually like them. Joan’s money
quote here comes from Greg Sargent, who got the partisan breakdown of a
recent Reuters/Ipsos poll (link).
Even Republicans like Obamacare, except for the part about extending
Medicaid to families with less than $30,000 annnual income:
* Eighty percent of Republicans favor “creating an insurance
pool where small businesses and uninsured have access to insurance
exchanges to take advantage of large group pricing benefits.” That’s
backed by 75 percent of independents. [...]
* Fifty two percent of Republicans favor “allowing children to stay on
parents insurance until age 26.” That’s backed by 69 percent of
* Seventy eight percent of Republicans support “banning insurance
companies from denying coverage for pre-existing conditions; 86 percent
of Republicans favor “banning insurance companies from cancelling
policies because a person becomes ill.” Those are backed by 82 percent
of independents and 87 percent of independents.
* One provision that isn’t backed by a majority of Republicans: The one
“expanding Medicaid to families with incomes less than $30,000 per
In light of this finding, some important observations need to be made.
First, Democrats and President Obama need to do a better job of
messaging. Secondly, despite the partisan rancor and win-at-all-costs
attitude of Republican party leaders, rank and file Republicans have a
lot in common with Independents and Democrats on this issue, and
probably a host of others. Third, this shows a lot of potential for
improvement in the tone of our national political dialogue if Republican
leaders can be shown to be out of step with rank and file Republicans.
With that thought in mind, let’s move to answer number two.
Answer number 2: Republican party leaders have become immoderate.
There are still plenty of moderate Republicans, but current party
leaders are more immoderate than moderate. Attitudes toward the
Affordable Care Act are just one case in point. Even Jeb Bush (link)
has noticed how immoderate party leaders have become on a whole range
of issues. As mentioned above, this at least gives potential for
improving the tone of national dialogue if we bypass Republican leaders
and appeal directly to rank and file Republicans and Independents.
But let’s focus just on the health care debate. First, there is the historical context. (link, link)
President Nixon, yes that President Nixon, proposed an employer mandate
for health care as a response to the idea of single payer health care
reform. During President Reagan’s second term, legislation was passed
that forced hospital emergency rooms to accept everyone, regardless of
whether they could pay. It was after that legislation was passed that
Republicans began to earnestly discuss a way to keep free riders from
taking unfair advantage of the law. The first available example of
this, dated October 2, 1989, comes from the Heritage Foundation’s Stuart
Some within the Republican party, most notably Peter Ferrara, have
sought to blame the Heritage Foundation for inventing and advocating for
the individual mandate. (link, link) Butler however says lots of others were discussing the individual mandate at the time (link):
My view was shared at the time by many conservative
experts, including American Enterprise Institute (AEI)
scholars, as well as most non-conservative analysts.
Even libertarian-conservative icon Milton Friedman, in a
1991 Wall Street Journal article, advocated replacing
Medicare and Medicaid "with a requirement that every
U.S. family unit have a major medical insurance policy."
In 1991, President George H. W. Bush commissioned a study, headed by Mark Pauly. (pdflink)
In a 2011 interview with Ezra Klein, Pauly discussed the experience,
explaining that Republicans were looking for a market-based option to
I was involved in developing a plan for the George H.W. Bush
administration. I wasn't a member of the administration, but part of a
team of academics who believe the administration needed good proposals
to look at. We did it because we were concerned about the specter of single payer insurance, which isn't market-oriented,
and we didn't think was a good idea. One feature was the individual
mandate. The purpose of it was to round up the stragglers who wouldn’t
be brought in by subsidies. We weren’t focused on bringing in high
risks, which is what they're focused on now. We published the plan in
Health Affairs in 1991. The Heritage Foundation was working on something
similar at the time.
Shortly thereafter, President Clinton sort of co-opted the Nixon
position by proposing an employer mandate. Republicans, who had already
been discussing the issue during George H. W. Bush’s presidency,
responded to President Clinton by focusing on their own mandate. As
noted by Len Nichols of the New America Foundation in a February 2010
NPR broadcast (link)
(T)he individual mandate was originally a Republican idea.
"It was invented by Mark Pauly to give to George Bush Sr. back in the
day, as a competition to the employer mandate focus of the Democrats at
This is also confirmed by Newt Gingrich (link):
“In 1993, in fighting ‘Hillarycare,’ virtually every
conservative saw the mandate as a less dangerous future than what
Hillary was trying to do,” Newt Gingrich, the former speaker of the
House, said at a debate in December, casting his past support of a
mandate as an antidote to the health care overhaul proposed by Hillary
Rodham Clinton during her husband’s administration.
As carefully illustrated recently by Ezra Klein (link),
moderate Republicans were accepting this mandate idea until June of
2009. This included plans endorsed by a majority of Republican
senators in 1993 (link) and bipartisan bills introduced in January 2007 and February 2009 (link) By December of 2009, after the Affordable Care Act was introduced, the mandate idea was suddenly unconstitutional:
KLEIN: Six months later, in December 2009, every single Senate
Republican voted to call the individual mandate unconstitutional, every
single one. That included many who has supported the individual in the
past, like Senator Hatch from Utah and Senator Bond from Missouri, and even
some supporting the mandate at that very moment, with their names on the
Health Americans Act like Senators Lamar Alexander and Mike Crapo.
It was just previous to this sudden change of heart by Republican party
leaders that Governor Mitt Romney introduced what has come to be known
as “Romneycare” in 2007. At the signing of Romneycare, Robert Moffitt,
who worked for the right-wing-think-tank Heritage Foundation, came to
Besides the support from the Heritage Foundation, the plan was approved
by two conservative Republicans who were secretary of the Health and
Human Services Department under George W. Bush, Tommy Thompson and Mike
In 2007, even conservative icon Jim Demint had glowing comments about
Romneycare and proposed it as a solution for the nation:
Needless to say, the Affordable Care Act, aka Obamacare, was based on
Romneycare, which was based on an idea proposed by moderate Republicans
and accepted even by conservative Republicans like Jim Demint.
Accepted, that is, until it was co-opted by President Obama.
Romneycare, not long ago openly lauded by many Republicans, and
Obamacare are nearly identical. President Obama’s signature proposal is
based on the same Republican ideas. (link, link) The most convincing discussion of this may come from extremely conservative Republican Peter Ferrara (link), who calls out Ann Coulter (link) when she tries to deny the similarities:
No, Ann, it's a lot more than that. Where did you get that
excessively speculative rationalization? Romney's health care bill is
perceived as virtually the same thing as the widely detested Obamacare
because it is virtually the same thing as the widely detested Obamacare.
Both Romneycare and Obamacare include the individual mandate. Both
Romneycare and Obamacare include sharp increases in Medicaid. Both
Romneycare and Obamacare include guaranteed issue and community rating
(like requiring fire insurers to insure homes that have already caught
fire, and at the same standard rates as for everyone else). Both
Romneycare and Obamacare include welfare subsidies for the purchase of
health insurance well into the middle class. And both Romneycare and
Obamacare include the latent government power for price controls on
health insurance and rationing of health care.
The problem is not that President Obama is a raging
socialist/leftist/fascist trying to force a health care mandate on
hapless stalwart Republicans. No, the problem is that the Republican
party leadership has become so immoderate that President Obama’s
obviously moderate Republican idea is no longer acceptable to them even
though the contents of his legislation are, mostly, accepted by rank and
Answer number 3: Negative propaganda.
Back before Mitt Romney was the Republican nominee, his rivals and
their supporters were more than willing to lament the negative impact of
Romneycare on the Massachusetts economy. As a case in point, Newt
Gingrich, who lauded Romneycare in 2006 (link) said in December of 2011 that (link):
“Why doesn’t Mitt admit it? He’s still for the mandate in Massachusetts. It doesn’t work, it’s going to bankrupt the state.
Peter Ferrara, of anti-mandate fame, said (link):
That means the mandated health insurance will inevitably be extremely expensive, as we are just starting to see with Obamacare.
The best antidote to negative propaganda is a good dose of reality. Romneycare is succeeding (link):
Currently, Massachusetts has the highest level of healthcare
coverage in the country with more than 98 percent of its residents
having healthcare insurance, but ranking as the 48th lowest state in the
nation in healthcare expenditures.
The combined saving of last year and this year will save the state
approximately $91 million with no benefit reductions or member co-pay
increases, the report said.
More success here and from the Frumforum here.
And, since Obamacare is very similar to Romneycare, Obamacare will also likely succeed in the end.
Conclusion: Agree with yourself
Republican party leaders have clearly lost their moral compass. One
way of saying this is that they no longer agree with their former
selves. In stark contrast, Mark Pauly, recognized by many as the father
of the individual mandate has maintained his Republican values over the
years. Snippets from various interviews show that he still prefers a
non-mandate solution but thinks it is the only way to insure everyone.
This is what rational Republicans sound like:
And how does economist Pauly feel about the GOP's retreat
from the individual mandate they used to promote? "That's not something
that makes me particularly happy," he says.(link)
“My view was, I still agree with myself,” he said in an interview. (link)
I have mixed feelings about the mechanics of the current bill. Our
idea was to have tax credits and very little additional government
control over insurance markets, and the legislation has an awful lot of
that. I believe you could achieve almost the same reduction of the
uninsured with the subsidies and without the mandate. But CBO says that
you leave about 40 percent of the uninsured population without coverage
in that scenario. If we want to close that gap, then either we have to
have a mandate or make insurance free for everyone and run by the
Incidentally, Pauly, in an interview that predates (February 2011) the
recent Supreme Court decision on the mandate, also confirms that the
mandate was originally considered as a tax back when it was first
proposed by Republicans (link):
Was the constitutionality of the provision a question, either in your deliberations or after it was released?
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. You
either paid the tax and got insurance that way or went and got it
another way. So I've been surprised at that argument. But I’m not an
expert on the Constitution. My fix would be to simply say raise
everyone’s taxes by what a health insurance policy would cost --
Congress definitely has the power to do that -- and then tell people
that if they obtain insurance, they'll get a tax break of the same
amount. So instead of a penalty, it’s a perfectly legal tax break. But
this seems to me to angelic pinhead density arguments about whether it’s
a payment to do something or not to do something.
See Votes by State
News & Politics