Following the U.S. Supreme Court's somewhat surprising ruling to uphold the Affordable Care Act, discussion now centers on a political verdict this November. Presumptive GOP presidential nominee Mitt Romney says he will recommend repeal on his first day in office.
If Romney has Republican majorities in the U.S. House and Senate, he may get his wish. The GOP majority in the House is voting today for the 31st time to repeal the act, which is a non-starter in the Democratically controlled Senate.
The venom over ObamaCare voiced in talk show commentary, letters to the editor and Republican speeches seems oddly out of touch with the history of the Act's most controversial provision — the individual health insurance mandate.
The idea emerged from the Heritage Foundation in 1989, which linked the mandate to its conservative political philosophy of individual responsibility. Early supporters included Utah Senator Orrin Hatch and then-Massachusetts Governor Mitt Romney. The 2006 Massachusetts universal health care law includes an individual health insurance mandate.
San Francisco Chronicle writer Debbie Saunders commented, "Mitt Romney, the former Massachusetts governor, the party’s all-but-certain nominee, is the only Republican in the country who imposed a health care plan with an individual mandate on his state. Romney used to call the provision 'the ultimate conservative idea,' as it told citizens that they’d get government help only if they couldn’t afford to take care of themselves. Team Obama is so smitten with Romney’s past that White House aides often credit Romney with coming up with the template for ObamaCare."
So how did an idea with such strong conservative appeal turn into anathema among conservatives? Ezra Klein, writing in The New Yorker, attributed it to politics. Republicans hated to see Obama score a major political victory.
However, a deeper analysis suggests many Republicans — and a fair number of Democrats — grew worried that achieving universal access without significant health care cost controls would push the price of health care up, not down. The Los Angeles Times reported in 2009 that the individual health care mandate without cost controls would "add up to higher costs for taxpayers and consumers."
The cost of health care is a concern shared widely over the political spectrum. It is likely to become the next battleground, regardless of whether the Affordable Care Act remains in place or not.