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Clinton, Obama and Massachusetts health reform: Untangling the confusion

Clinton, Obama and Massachusetts health reform: Untangling the confusion

April 28, 2008

Yale political scientist and health reform expert Jacob Hacker has written an important post untangling the confusion many feel in the back-and-forth between Clinton and Obama over health care (read it here). Hacker explains how the virtually identical structure in both candidate's plans have been hidden in the vitriol over their modest differences:

So what’s the main story: (1) a basic Democratic consensus about what should be done, or (2) a widening policy divide fueled by presidential ambitions? The answer is (1), but unfortunately, the reality of (2) is increasingly upstaging this welcome development. And, unfortunately, this unnecessary and self-defeating conflict could ultimately derail efforts at reform, confusing and turning off the very voters Democrats need to woo.

The bitter Clinton vs. Obama public argument over the individual mandate leads people to compare their plans to Massachusetts health reform. But both plans are quite different than chapter 58:

Massachusetts has taken a very different route than Senators Clinton and Obama envision. Massachusetts basically adopted an individual-market model: People without coverage from their employer need to actively seek it out. The cornerstone of both candidates’ plans, by contrast, is the play-or-pay requirement: employers cover their workers, or their workers are automatically enrolled in a single insurance pool to which employers are required to make contributions. ...

Done correctly — with businesses reporting whether they cover their workers to the federal government, which then enrolls uninsured employees and their dependents — a play-or-pay requirement makes covering people much less complicated. The more than 90 percent of non-elderly Americans (and more than 80 percent of the uninsured) who live in a family in which someone works would be enrolled automatically through the workforce. Many of those missed are already covered through public programs, and aggressive outreach could reach those who still remain without coverage. Thus, Mr. Obama’s plan could well cover almost everyone even without the individual mandate.

Last week the campaigns continued their health care attacks (see this Obama ad and this Clinton response. Hacker urges the candidates to focus on affordability, enrollment strategies, and how they would provide portable health security to everyone.
Brian Rosman