Hillary Clinton discusses enforcement mechanism for health insurance mandate

Democratic presidential candidate Sen. Hillary Rodham Clinton (N.Y.) on Sunday during an appearance on ABC's "This Week with George Stephanopoulos" discussed her proposal to require all U.S. residents to obtain health insurance and "inched closer ... to explaining how she would enforce" the requirement but "declined to specify -- as she has throughout the campaign -- how she would penalize those who refuse," the New York Times reports.

Asked whether she would garnish wages to enforce the mandate, Clinton said that "we will have an enforcement mechanism, whether it's that or it's some other mechanism through the tax system or automatic enrollments" (Sack, New York Times, 2/4). Clinton explained she believes "there are a number of mechanisms" that could work including "going after people's wages." Clinton also said that the enforcement mechanism would apply only to residents who can afford health insurance but refuse to purchase coverage, adding that, with her proposals for subsidies, "it will be affordable for everyone" (Babington, AP/Houston Chronicle, 2/3).

She also said that the focus on an enforcement mechanism took attention from differences in her health care proposal and the plan announced by rival Sen. Barack Obama (Ill.). His proposal would require health insurance only for children and would leave some residents without coverage, she said.

Bill Burton, a spokesperson for Obama, said that Clinton "again refused to directly answer the question" about the enforcement mechanism. He added, "America needs a leader they can trust, not someone who will avoid hard questions."

Obama Campaign Mailer
The Obama campaign last week distributed a mailer that said, "Hillary's health care plan forces everyone to buy insurance, even if you can't afford it ... and you pay a penalty if you don't" (New York Times, 2/4).

Neera Tanden, policy director for the Clinton campaign, said that the Clinton health care proposal includes subsidies to help residents cover the cost of health insurance, as well as provisions to reduce the cost of coverage. According to Tanden, Obama "betrays the cause of universal health care." She added, "For a potential Democratic nominee to be attacking universal health care is quite stunning" (Fouhy, Associated Press, 2/1).

The Clinton campaign also criticized the mailer for the use of images that resemble those used in the "Harry and Louise" television advertisements aired by American's Health Insurance Plans in the 1990s to help defeat her health care proposal. Len Nichols of the New America Foundation said, "I am personally outraged at the picture used in this mailing," which he called a "Harry and Louise evocation" (Smith, "Ben Smith" blog, The Politico, 2/1). A link to a portion of the mailer is available online at politico.com.

David Axelrod, chief strategist for the Obama campaign, defended the mailer. He added that the Clinton campaign has "spent a lot of money in this campaign to distort our health care plan" (Zeleny/Healy, New York Times, 2/2).

Burton also noted comments by Sen. Ted Kennedy (D-Mass.), who endorsed Obama last week. "It's the passion of my life, universal comprehensive health care, and I wouldn't support Barack Obama unless I was absolutely convinced that he was for universal comprehensive health care as well," Kennedy said. "I've tried for 38 years to get the universal comprehensive health care. I've supported 12 different proposals to try to get there. Elect Barack Obama and we will get there" (Associated Press, 2/1).

Also, according to the New York Times, "A group of doctors and health policy analysts, including a number of Obama advisers, pointed out in a letter released Thursday that Massachusetts, the only state with an insurance mandate, has thus far failed to enroll nearly half of its uninsured despite imposing a modest first-year tax penalty of $219 (the fine increases significantly this year)." A copy of the letter is available online at huffingtonpost.com.

Clinton would not "allow exemptions from the insurance mandate, as Massachusetts does," according to the Times (New York Times, 2/4).

Clinton Addresses Health Care at Campaign Events
Clinton on Saturday during an event at the California State University-Los Angeles that targeted Hispanic voters said, "My opponent will not commit to universal health care." She added, "I do not believe we should nominate any Democrat who will not proudly stand here today, tomorrow and the next day and say universal health care is the goal" (Sweet, Chicago Sun-Times, 2/3).

Later on Saturday, Clinton during an event in Tucson, Ariz., said, "He doesn't have a universal health care plan, and I think as a Democrat, if we're going to run against the Republicans, let's run on our principles." She added, "Unless we get everybody covered with insurance, we'll never be able to improve health care, reduce costs. We'll never be able to rein in the insurance companies because they'll always be able to cherry-pick" healthy residents and reject those with pre-existing conditions (Scarpinato, Arizona Daily Star, 2/3).

Voter Survey
Sixty percent of Democratic voters and 40% of Republican voters believe that the presidential candidates have not adequately discussed health care issues in their campaigns, according to a recent survey conducted by the Susan G. Komen for the Cure Advocacy Alliance.

The survey found that about 40% of voters said that they are not satisfied with the health care proposals from the candidates. In addition, 62% of voters cited breast cancer as the most important health issue for women, followed by heart disease, and ovarian and cervical cancers, according to the survey. The survey also found that 71% of Democratic voters and 46% of Republican voters would support a federal tax increase to expand access to breast cancer tests and treatment for all women (Grimaldi, CQ HealthBeat, 2/1).

Broadcast Coverage
Three broadcast programs recently reported on health care in the presidential election. Summaries appear below.

• ABC's "This Week": The segment includes a discussion with Clinton on her health care proposal and other issues (Stephanopoulos, "This Week with George Stephanopoulos," ABC, 2/3). Video of the segment and expanded ABC News coverage are available online. A transcript of the complete interview also is available online.
• CNN's "American Morning": The segment includes a discussion with CNN medical correspondent Sanjay Gupta about health care proposals from Clinton and Obama (Roberts, "American Morning," CNN, 2/1). Video of the segment is available online. A transcript of the segment also is available online.
• CNN's "Open House": The segment includes a discussion with Gupta about health care proposals from presidential candidates (Willis, "Open House," CNN, 2/2). Video of the segment is available online. A transcript of the complete program also is available online.