On the campaign trail, Barack Obama repeatedly argued against the passage of a federal mandate to purchase health insurance. Once in the White House, however, he signed a signature health law that included a mandate. Why did he change his mind? The New Yorker's Ryan Lizza, who previously uncovered evidence that Obama signed off on health budgeting "gimmicks," has posted a revealing White House memo from Nancy-Ann DeParle, the administration's point person on health reform, to President Obama.
In the memo, which was sent in April of 2009, as the health reform battle was just warming up, DeParle advises President Obama on the state of the legislation, asks him to make a choice about whether or not to finally endorse a mandate, and seems to nudge him in the direction of saying yes. It worked. By mid-summer, Obama publicly supported a mandate.
Lizza offers two takeaways from the memo. The first is that President Obama felt some pressure based on scores from the Congressional Budget Office (CBO). The memo notes that without a mandate, the CBO would score the legislation as being a little less expensive but also far less effective in terms of coverage. In the memo, DeParle writes that leaving out the mandate "reduces federal costs—by roughly $270 billion over 10 years—but also reduces coverage (insuring that only 28 of the projected 56 million uninsured in 2014)." According to Lizza, Obama was so frequently irritated with the Congressional Budget Office that at one point he refused to let anyone name the agency in his presence:
This was not the last time that the C.B.O., which “scores” all legislation and has a major influence on how issues are framed in Washington, would force Obama’s hand on a significant aspect of health-care policy. In fact, Obama became so frustrated with the C.B.O. that at one point during the health-care debate he banned his aides from using the term “C.B.O.” in his presence. Instead, the President called the C.B.O. “banana.”
Finally, Lizza points to another passage in the memo in which DeParle specifically points out that Massachusetts had already passed a mandate with some income-based exemptions that might help assuage the president's concerns about the provision. Congratulations, Republicans: Your presidential primary frontrunner passed the health plan that helped convince President Obama to support a mandate.