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Mitt Romney's Epic Health Care Journey: How He Flip-Flopped On Mandates

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1994: Supports A Federal Mandate

Romney's first pass at the mandate issue came in 1994, when he told The New Republic's John Judis in an interview that he backed moderate Republican Sen. John Chafee's (R-ME) health care bill as an alternative to President Clinton's plan. Progressive bloggers and Democratic operatives have circulated the profile in recent days, noting that Chafee's proposal included a federal mandate. From the TNR article:

The question about Romney is where he would stand in Congress's internecine battles. Would he side with Republicans such as John Chafee who have tried to develop constructive alternatives to Democratic legislation or with Republicans such as Phil Gramm and Newt Gingrich who have been willing to paralyze Congress for the sake of embarrassing the Clinton administration? Romney has indicated that he would side with the moderate wing. He endorsed the crime bill and refused to back Gingrich's jejune "Contract with America." He told me he would have backed Chafee's health care bill. "I'm willing to vote for things that I am not wild with," he said.

2008: State Mandates For Everyone

By the time Romney ran for president in 2008, he was more wedded to the individual mandate than ever, having included the insurance requirement in his landmark health care law as governor. But his official position as a presidential candidate was that other states' should be left to decide the issue on their own.

"A one-size-fits-all national system would fit no one because it ignores the very dramatic differences that exist between states and the health insurance markets in them," he wrote in a 2007 op-ed for Modern Healthcare. "Thus, the federal government should facilitate reform and give states flexibility to design their own programs."

But that didn't mean he had backed away from his own state's approach. To the contrary, he repeatedly made clear that he thought Massachusetts' law, which he termed a "model for the nation" in one speech, would catch on throughout the country -- especially its mandate.

"We have to have our citizens insured," he said in a presidential primary debate in Iowa in August 2007. "And we're not going to do that by tax exemptions because the people that don't have insurance aren't paying taxes. What you have to do is what we did in Massachusetts. Is it perfect, no? But we say let's rely on personality responsibility. Help people buy their own private insurance. Get our citizens insured, not with a government takeover, not with new taxes needed, but instead with a free market-based system that gets all of our citizens in the system. No more free rides."

Romney expressed similar sentiments in interviews, telling Tim Russert on Meet The Press in December 2007 that he believed other states would ultimately determine that mandates were right for them.

"I'd think it's a terrific idea," Romney told Russet when asked whether other states should impose an individual mandate. "I think you're going to find when it's all said and done, after all these states that are the laboratories of democracy, get their chance to try their own plans, but those who follow the path that we pursued will find it's the best path, and we'll end up with a nation that's taken a mandate approach."

2009: Federal Mandates Come Back In Style

While Romney stopped short of endorsing a federal mandate during his presidential run, things changed dramatically after President Obama took office and began pushing his own health care effort. Just as he did in 1994, Romney threw his weight behind a moderate bill in Congress, this time crafted by Sens. Ron Wyden (D-OR) and Bob Bennett (R-UT), that -- like Obama's plan -- contained an individual mandate and used subsidies to help Americans purchase insurance.

In a June 28, 2009 appearance on Meet The Press, Romney repeatedly name-checked Wyden-Bennett, which he enthusiastically linked to his own health care plan in Massachusetts.

"It's important for us to have a stronger message as we go forward, and I think the party does have to stand up and be able to say, 'Listen, Mr. Axelrod, you're wrong when you say we don't have ideas. We have a health care plan,'" he said. "You look at Wyden-Bennett. That's a health care plan that a number of Republicans think is a very good health care plan -- one that we support. Take a look at that one."

Romney added that the bill would solve what he considered the most dangerous portion of the Democrats' proposal, and one that was ultimately left out of the law -- a public insurance option.

"It would become larger and larger, drive the private options out of the health care industry," he said. "It would be just disastrous for health care in this country. And, therefore, the right way to proceed is to reform health care. That we can do as we did it in Massachusetts, as Wyden-Bennett is proposing doing it at the national level."

2011: Actually, Federal Mandates Are Unconstitutional

Wyden-Bennett, however, proved to be a death sentence for one its co-authors. Sen. Bennett lost the GOP nomination for his own seat the next year in part due to a conservative backlash against the once-obscure bill. Romney received the message loud and clear, insisting again in interviews that he would not impose a federal individual mandate as president and bristling at any comparisons between Massachusetts' reforms and the Affordable Care Act. Despite his earlier support for two pieces of federal legislation that included a mandate, he joined Republicans in labeling the policy unconstitutional.

"I'm not apologizing for it, I'm indicating that we went in one direction and there are other possible directions," he told ABC News in February 2011, when asked about his health care record as governor. "I'd like to see states pursue their own ideas, see which ideas work best."