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Now-shunned mandate creates complications for GOP

The individual mandate used to be the new black – even within Republican circles.

In the early 1990s, the conservative Heritage Foundation floated health care requirements similar to those that require drivers to get liability insurance. Republican Sen. John Chafee of Rhode Island put forward a GOP plan that would require all U.S. residents to be covered under a health plan except those exempted for religious reasons.

And several big thinkers who would be interested in running for president two decades later also liked the sound of it.

Heritage and other conservative bigs later pronounced the individual mandate unlawful and ineffective, and judicial scholars are now in the throes of debate over whether the requirement is even Constitutional under the Commerce Clause. But past Republican approval of the individual mandate – often phrased as a matter of ‘personal responsibility’ – planted the seeds of what is now playing out as an internecine struggle among Republicans eying the Oval Office.

Last week, former Massachusetts Gov. Mitt Romney used a lengthy speech and a PowerPoint presentation to explain his embrace of an individual mandate in the health care plan he signed into law in 2006. (Romney believes that such a mandate at the state level was appropriate under the 10th amendment, although his proposal to repeal and replace the Obama-passed law now would not involve a similar requirement.)

The requirement may cause headaches for Indiana Gov. Mitch Daniels as well, if he decides to launch a presidential bid. On Thursday, the Huffington Post unearthed a 2003 newspaper article in which Daniels said he favored a “universal health care system” that would “make it mandatory for all Americans to have health insurance.”

Former House Speaker Newt Gingrich has faced the most sustained criticism on this point since Sunday, when he stated on NBC’s Meet the Press that “all of us have a responsibility to help pay for health care.”  Gingrich made the comment after host David Gregory showed a clip from 1993 in which Gingrich said he was for a plan “exactly like automobile insurance – individuals having health insurance and being required to have health insurance.”

Conservative radio host Rush Limbaugh challenged Gingrich on Thursday to explain those and subsequent comments that have been supportive of the requirement that almost all U.S. residents buy health insurance.

The former Speaker responded that the Republican party has gone through “a long evolution” on the subject since the early 1990s.

“In 1993, we were narrowly focused on trying to beat the Hillarycare project,” he said in reference to the Clinton-backed health care overhaul that ultimately disintegrated in Congress. “We weren’t thinking fundamentally about resetting the country.”

Gingrich says now that he opposes mandates at the state and the federal level.

“I do not believe any state should adopt a mandate,” he said.  “I think there are ways to solve the problem without a mandate. But we’re trying to solve three things: Preserve American freedom, ensure that people can have health care, and have some sense of responsibility that if you do get health care, you ought to pay for it.”

Gingrich pushes back on Ryan reference
On Limbaugh’s radio program, Gingrich also pushed back at the notion that he linked Rep. Paul Ryan’s budget plan to “right-wing social engineering” – a phrase he uttered on Meet the Press that later prompted the former Speaker to call Ryan personally to apologize.

“It was not a reference to Paul Ryan,” Gingrich said. “There was no reference to Paul Ryan in that answer."

Here’s the transcript to the portion of the Meet the Press interview:

 MR. GREGORY: What about entitlements? The Medicare trust fund, in stories that have come out over the weekend, is now going to be depleted by 2024, five years earlier than predicted. Do you think that Republicans ought to buck the public opposition and really move forward to completely change Medicare, turn it into a voucher program where you give seniors...

REP. GINGRICH: Right.

MR. GREGORY: ...some premium support and--so that they can go out and buy private insurance?

REP. GINGRICH: I don't think right-wing social engineering is any more desirable than left-wing social engineering. I don't think imposing radical change from the right or the left is a very good way for a free society to operate. I think we need a national conversation to get to a better Medicare system with more choices for seniors. But there are specific things you can do. At the Center for Health Transformation, which I helped found, we published a book called "Stop Paying the Crooks." We thought that was a clear enough, simple enough idea, even for Washington. We--between Medicare and Medicaid, we pay between $70 billion and $120 billion a year to crooks. And IBM has agreed to help solve it, American Express has agreed to help solve it, Visa's agreed to help solve it. You can't get anybody in this town to look at it. That's, that's almost $1 trillion over a decade. So there are things you can do to improve Medicare.

MR. GREGORY: But not what Paul Ryan is suggesting, which is completely changing Medicare.

REP. GINGRICH: I, I think that, I think, I think that that is too big a jump. I think what you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options, not one where you suddenly impose upon the--I don't want to--I'm against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change.