On Monday, Dr. Robert Moffit, the director of the Heritage Foundation’s Center for Health Policy Studies, disavowed his organization’s old ideas in a Washington Post editorial titled “Obama’s health reform isn’t modeled after Heritage Foundation ideas”.
Moffit, who was part of the Heritage Foundation team which drafted a plan including the individual mandate as a response to President Clinton’s proposal in the early 1990s, now rejects the individual mandate as “operationally ineffective and legally defective”.
In an exclusive interview with FrumForum, Moffit denied that the Heritage Foundation’s shift was political, asserting that it had happened over the course of several years, and that Heritage had rejected the individual mandate before President Obama had even come to office.
According to Moffit, healthcare reform as a central political issue “largely disappeared, for the most part” between President Clinton’s efforts in the early 1990s and around the time of Massachusetts’ healthcare reform. When the issue of an individual mandate came up again, Heritage had changed its mind on the issue.
In talking about the Massachusetts system, Moffit emphasized the Foundation’s efforts in planning the state-based health insurance exchanges. Asked whether Heritage was involved in the individual mandate aspect of the reform, Moffit said, “Well, not very much.” Moffit insisted that he had been against the individual mandate for several years, pointing to an article that he wrote in 2006 which blasts the individual mandate.
According to Moffit, the crystal clear shift in Heritage healthcare policy came in 2007:
In 2007, my boss, [Heritage Foundation Vice President of Domestic & Economic Policy] Stuart Butler had written a major article for Brookings… and he basically started making it clear that the individual mandate was not the way to go.
But why the shift? If Heritage had decided that the individual mandate was necessary in the 1990s, why did they find it untenable fifteen years later? In his Washington Post editorial, Moffit claimed that Heritage changed its stance because of new facts and deeper analysis.
What new facts? Moffit said that the key data Heritage looked at was compliance data, and the effectiveness of government mandates in ensuring high levels of compliance:
One of the things we started looking at was: does the individual mandate get you to universal coverage? Or, is there another way to do it? We looked at the data for [things like] auto insurance and federal mandates for tax filing, and registration for the draft, for example. None of these mandates give you universal coverage.
One of the studies that Moffit cites as evidence is an article by the National Center for Policy Analysis, which claims that 14.6% of American drivers remained uninsured, despite mandates in every state; it also says that some of the least punitive states featured the lowest levels of noncompliance.
With ideas like this in mind, Moffit claims that Heritage reevaluated their goals thusly in 2005/2006:
So the question [was]: what are we trying to do here? We’re trying to get as many people “insured as possible. There are other ways to do this!
Asked what the Heritage Foundation would propose to do in order to increase coverage, Moffit said:
Our [current] view is that there are better ways to [expand coverage]: through positive tax incentives and things like options for enrollment at the place of employment, auto-enrollment with the right to refuse, is going to get you the same level of coverage.
Of course, experience has shown that state-based healthcare mandates have been more effective than auto insurance mandates. In Massachusetts, where there is a healthcare insurance mandate, 97% of its residents are now covered.
So if we actually look at the experience of the health insurance mandate in Massachusetts, we find that health insurance mandates can actually lead to very high compliance. Despite this, Heritage remains staunchly against the concept. As such, it seems as though the shift in Heritage’s stance towards the individual mandate is not based on “new facts”, as Moffit claims, but rather a new focus.
Indeed, it appears as though Heritage’s primary goal with regards towards healthcare reform has shifted from simply expanding coverage to preferring more ideologically pure reforms that place a healthy “bias towards liberty”.
The notion that President Obama’s federal health insurance exchanges were built off Heritage’s Massachusetts plan is also something that the Foundation’s top healthcare scholar vehemently denies. “‘Exchange’ is a word, which can mean many different things… [President Obama] uses the word in one way, we use the word in another way,” he said.
Moffit also dislikes the President’s healthcare exchanges primarily because they would serve as a platform for a federal public option:
The only reason why he would create a national health insurance exchange is to have a platform for a public plan that would compete against private plans… We have a national market in lettuce. You don’t need a lettuce exchange.
Finally, suggestions that Heritage only opposes Obamacare because it was proposed by a Democrat are “low blow[s],” said Moffit.
In fact, Moffit continued, the most cynical political maneuvering was pulled off by the president, who sought political cover by using terms and phrases which conservative groups like the Heritage Foundation could agree with, even as he had no intention to negotiate:
He used broad themes … like we need to expand coverage to people who don’t have coverage today… [but] broad phrases like the use of ‘health insurance exchanges’ and ‘cost control’ mean absolutely nothing… It’s the details that determine where you end up. And it was very clear from the beginning that Obama’s agenda was radically different from that of the Heritage Foundation.