chAPTER ThiRTEEn • DomEsTic AnD Economic Policy 301
Individual Mandate
In health-care reform,
the requirement that all
citizens obtain health-care
insurance coverage from
some source, public or
private.proposals through the legislative process without significant alteration. Obama’s tactics
eliminated much of the tug-of-war between Congress and the president that had been
commonplace in past decades, but the political cost of letting Congress take the lead
turned out to be high. Much of the political maneuvering required for passage was highly
unpopular with the public.The issue of mandated coverage. One key element of the proposed legislation was
the individual mandate. Congressional Democrats adopted the individual mandate
because without it, there was no way that the numbers would add up. Universal coverage
was impossible unless everyone—healthy and sick alike—chipped in. Unfortunately for the
Democrats, the individual mandate allowed the Republicans to accuse the Democrats of
“forcing” people to do something, never a popular position in America.new Taxes. Funding the legislation required additional taxes. Democrats in the House
called for heavier taxes on the rich, while the Senate proposed taxes on drug and insur-
ance companies. In the end, the two chambers compromised on some of each.Public Reaction. Initially, popular support for health-care reform, as reported by opinion
polls, was relatively high. Support eroded quickly, however, as Congress took up the actual
legislation. The process of moving the reform through congressional channels gave the
public a close look at how legislatures operate, and many citizens clearly were not happy
with what they saw.Passage. The House passed its bill in November 2009, and the Senate passed its version
in December. Passing the reform legislation became more complicated in January 2010,
after Republican Scott Brown
won a Massachusetts special elec-
tion to fill a vacant U.S. Senate
seat. The election meant that the
Senate Democrats lost their sixti-
eth vote, which was necessary to
end filibusters. If the House and
Senate versions of the bill were
reconciled in a conference com-
mittee—the normal procedure—
Senate Democrats would not be
able to pass the resulting compro-
mise, and the entire reform effort
would collapse.
President Obama and then
House Speaker Nancy Pelosi, how-
ever, patiently assembled enough
Democratic support in the House
to pass the Senate bill unaltered,
thus eliminating the need for
a conference committee. The
House then immediately passed
a reconciliation act, which was
not subject to Senate filibuster.A miami physician inoculates a thirteen-year-old patient with a vaccine.
In 2013, Florida Republican governor Rick Scott reversed his position and supported an
expansion of Medicaid under the federal Affordable Care Act. (Joe Raedle/Getty Images)Copyright 2014 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
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