Obama-Clinton Politics of Health Mandate Now Playing in Mass.

By | March 3, 2008

Barack Obama is no fan of the individual mandate that has been central to the successful launch of the Massachusetts universal health care law. He likes to cite its foibles as he criticizes his Democratic presidential rival, Sen. Hillary Rodham Clinton of New York, for including a similar mandate in her national health care plan.

Gov. Deval Patrick has been noticeably silent as Obama has leveled his criticisms, as he did during a nationally televised debate this past week. It turns out it’s not just because he has endorsed his fellow Chicagoan for president.

Patrick, it sounds, has a lukewarm view of his current homestate’s provision himself.

“It’s a feature,” was what the governor first mustered last Wednesday when asked about the mandate. It required everyone in Massachusetts to have some form of health insurance by Jan. 1.

Patrick went on to say, “I think it’s a component; if it were freestanding, if it were all on its own, it wouldn’t make any sense. Otherwise, you could cure homelessness by ordering everybody to buy a house.”

The governor added that requiring people to get health insurance — which has proved fundamental in helping reduce the number of insured in the state by 300,000 since the law went into effect — will make no sense going forward if premium costs continue to rise.

Fresh proof of that challenge came on Thursday, when state officials postponed a meeting where they were to consider rate increases for those buying subsidized policies. Bids from the four insurers who were to provide the coverage came in far over budget, so the officials were forced to consider alternatives.

“We have a whole lot more work to do to make the overall system costs affordable to people, and obviously, we want to make sure that we’re not penalizing people for not buying some thing they can’t afford,” Patrick said.

That is the principal criticism that Obama, the Illinois senator who currently is the front-runner for the Democratic nomination, makes as he touts his plan and criticizes Clinton by way of Beacon Hill.

Under the terms of the Massachusetts plan, the state government is providing free coverage to the most needy, offering subsidies for those struggling to pay the cost and has helped create discounted policies for those left to pay for coverage on their own.

Those who haven’t signed up face a series of escalating fines unless they get a hardship exemption, which would come into play if someone made too much to qualify for the subsidized coverage by not enough to pay for one of the discounted policies.

State officials have estimated that could be 60,000 people.

“I have no objection to Senator Clinton thinking that her approach is superior, but the fact of the matter is … we still don’t know how Senator Clinton intends to enforce a mandate, and if we don’t know the level of subsidies that she’s going to provide, then you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can’t afford it, even with the subsidies,” Obama said Wednesday night during a debate in Cleveland.

The senator added: “They are then worse off: They then have no health care, and are paying a fine above and beyond that.”

Patrick drew the line at that comment. He said he disagreed that anyone is worse off for the institution of the plan.

“No,” the governor declared. “The system as a whole is about getting insurance to everybody, but just ordering people to have insurance, without the other components, is just not going to work.”

He added: “A mandate with cost controls, and the other features of our system, including the subsidies where they apply, is part of what we have here and what we’re trying to make work.”

The bifurcated opinion illustrates two points.

First, the danger in endorsing someone for political office is that you can become liable for their negatives as much as you might become the beneficiary of their positives.

Former Massachusetts Gov. Mitt Romney had that reinforced during his unsuccessful campaign for this year’s Republican presidential nomination. He accepted the endorsement of Bob Jones III, a South Carolina university leader popular with evangelicals who also happens to think Romney’s Mormon faith is akin to a “cult,” as Jones has termed it.

That prompted uncomfortable questions for Romney, who ended up saying that accepting an endorsement didn’t mean he endorsed all the views of the person endorsing him.

Second, Patrick’s muted support for the mandate highlights his challenge as he implements a program signed into law by someone else. That someone was Romney, who himself vetoed the mandate just before he signed the bill into law in April 2006.

The Democratically controlled Legislature, which passed the bill into law, overrode that veto.

That has left Patrick walking the fine line between a policy that appears to be working and an enactment tool for which he — and Obama — have little regard.


EDITOR’S NOTE _ Glen Johnson has covered local, state and national politics since 1985. He can be reached at glenjohnson(at)ap.org.

Topics Massachusetts

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