When did conservatives stop loving Obamacare?

Consider a health reform plan based on the principle that “all citizens should be guaranteed universal access to affordable health care.” It accomplishes this goal with a government mandate that “every head of household…acquire at least a basic health plan for his or her family.”

The plan would couple this mandate with tax subsidies to help low and middle income families afford coverage.

Sound familiar? It should, because it’s the essence of Obamacare.

But President Obama wasn’t the first to propose such government intervention into health insurance markets. The quotes above come from reports of the Heritage Foundation, a conservative think-tank and mainstay of Republican policy development. Heritage describes itself as promoting “conservative public policies” based on principles such as free enterprise, limited government, and individual freedom.

Heritage first proposed its idea back in 1989. Its analysis pointed out that many states “require anybody driving a car to have liability insurance” but that “neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness.” The analysis concluded, “Under the Heritage plan, there would be such a requirement.” (Click here to read it.) Heritage added more details in a follow-up report published in 1990. (Click here to read that one.)

Is this ancient history? What has Heritage said about its proposal more recently?

In 2006, the Heritage framework formed the basis for the Massachusetts reform plan promoted by Governor Mitt Romney (sometimes referred to as “Romneycare”), a plan that Heritage praised as “transformative.” In Heritage’s words, “the cornerstone for this plan is the personal responsibility principle [Romney’s term for the mandate].” In its view, the plan’s strengths include “creatively” using a Medicaid expansion and allowing consumers to purchase coverage through a “health insurance exchange.” (Click here to read a detailed Heritage assessment of the Romney plan.)

Heritage reiterated its support for the Romney plan in 2007, describing it as a “breakthrough.”

Over the years since Heritage first laid out its plan, at least 25 prominent Republicans have endorsed it, including former House speaker Newt Gingrich, Utah Senator Orin Hatch, and former Pennsylvania Senator Rick Santorum. In 1993, 20 congressional Republicans signed on to legislation based on the Heritage approach.

But since 2007, Heritage has performed an extraordinary pivot. It now vehemently opposes its own ideas as incorporated into Obamacare. In 2009, it called the Obamacare mandate “unprecedented and unconstitutional.”

Since then, Heritage has repeatedly tried to distance itself from its proposal. In 2011, it filed a legal brief disavowing the 1989 analysis, while making no reference to its consistent support for the mandate concept over the next 18 years.

2012, Stuart M. Butler, author of the 1989 and 1990 analyses, explained that his views had “evolved” over time. It must have been a rapid evolution, since he had acquiesced in Heritage’s support for the Romney plan as recently as 2007.

Last week in its newsletter, Heritage reiterated its opposition to Obamacare, calling for full repeal, because it relies on a “flawed framework.” The article made no mention of where that framework originated.

To be fair, there are differences between the details of Heritage’s mandate proposal and those of Obamacare’s. However, the underlying concept is identical – stabilizing insurance markets by requiring everyone, healthy and sick, to buy in.

So, when did Heritage, a key force in formulating Republican health policy, stop loving its baby? Clearly, sometime between 2007, when it last praised the Romney plan, and 2009, when it first railed against Obamacare.

What changed during that time? An obvious difference is that its framework was embraced by a politician from the opposing party. Could the switch have been prompted by the change in partisan support for the plan? None of Heritage’s attempts at explanation suggest otherwise.

In other words, much of the opposition to Obamacare has nothing to do with ideology. It is based purely on partisanship.

Republicans are moving rapidly to repeal Obamacare, yet almost seven years after the law’s enactment, they still have no plan for replacement. The nonpartisan Congressional Budget Office recently projected that repeal alone would eliminate health insurance for 18 million Americans immediately and up to 32 million by 2026 and raise individual premiums by up to 25 percent immediately and 50 percent by 2026.

This is partisanship without principle. It is partisanship run amok.

-----

Have a health care question or frustration? Share your story »

Read more of Health Cents »