Democrats are bracing themselves for a new line of conservative attack against a provision in the health care legislation once considered so non-controversial that it was endorsed by several major Republican officials.
On Tuesday, Sen. Jon Kyl (R-Ariz.) described the health care legislation being considered by the Senate Finance Committee as a "stunning assault on liberty" due to a provision that would require individuals to buy insurance.
Earlier in the week, the individual mandate also came under attack when Tim Phillips, who heads Americans for Prosperity, described it as an assault on individual liberty.
"When you have health care, that's a choice that impacts yourself," Phillips told MSNBC's Hardball. "Drivers' insurance impacts other drivers you may have accidents with."
The attacks have confounded Democrats in and out of government, who noted quickly that mandating coverage was, until recently, a relative given when it came to health care reform.
"It's f--ing ludicrous," said one health care reform activist, who noted that when Finance Committee Chairman Max Baucus (D-Mont.) asked committee members to air their disagreements with an individual mandate during a meeting on May 5, no one chimed in.
Indeed, for months it was presumed that a relatively ironclad deal was in place: in exchange for the government mandating coverage, private insurance companies would agree to cover individuals with pre-existing conditions. The arrangement was all but blessed by prominent figures from within the GOP ranks. In mid-August, the ranking member of the finance committee, Sen. Chuck Grassley (R-Iowa), announced that the way to get universal coverage is "through an individual mandate."
"That's individual responsibility," the senator told Nightly Business Report. "And even Republicans believe in individual responsibility."
Months earlier, Grassley told Fox News that there wasn't "anything wrong" with mandates even if some may view them "as an infringement upon individual freedom."
"But when it comes to states requiring it for automobile insurance the principle then ought to lie the same way for health insurance," Grassley added. "Because everybody has some health insurance cost and if you aren't insured there aren't free lunches."
Grassley wasn't alone. His fellow Republican Senator John Thune (R-S.D.) recently told reporters that while he was conflicted on a mandate, it was "something I guess that I would take a look at. There -- there are good arguments on behalf of getting everybody in the -- in the pool," he said. Former Massachusetts Governor Mitt Romney made an individual mandate a staple of the health care overhaul he pursued for his state. "For the uninsured who can afford insurance but expect to be given free care at the hospital, require them to either pay for their own care or buy insurance," he wrote in Newsweek.
Former Senate Majority Leader Bill Frist, himself a doctor, told Fox Business Network that consumers should "be responsible to paying for" their insurance. If they can't afford it, he added, "there are going to be taxes, excise taxes, user taxes on companies like Aetna, on individuals."
Meanwhile, six current Republican Senators - Lamar Alexander (Tenn.), Bob Bennett (Utah), Mike Crapo (Idaho), Lindsey Graham (S.C.) and Judd Gregg (R-N.H.) - all have sponsored legislation (Sen. Ron Wyden's 2009 "Healthy Americans Act") that includes an individual mandate.
So why at this juncture has the individual mandate come under attack - enough to create concern within the Obama White House and Dems on the Hill? Health care reform advocates say that it is largely due to political opportunism on the part of Republicans. But sloppy legislating on the part of Democrats can also be blamed. Richard Kirsch, National Campaign Manager for Health Care for America Now, argued that the GOP clearly senses "a vulnerability for Democrats" on the topic. But the problem was that there were serious concerns that the legislation didn't include the subsidies needed to make mandated coverage more affordable -- a concern that even Barack Obama raised during the course of the Democratic primary, he noted.
"If you assume that the legislation will provide for affordable coverage for people than the individual mandate will not become a huge lightening rod," Kirsch said. "But if you are worried about federal spending levels and are therefore are not providing affordable coverage then it will become a political lightening rod."
Baucus (D-Mont.) has tried to remedy the situation by halving the penalty on families who decline to buy coverage and increasing the subsidies to those middle-class families purchasing insurance. But Kirsch insists that, without the ability to choose a government run option, consumers - and by extension the politicians who represent them - will turn sour on the mandate.
"We did a poll in Maine and in 91 swing House districts," said Kirsch. "We found that if we asked people if they supported a requirement to buy health insurance they said no. But if we said, 'Do you support a requirement coverage between private and public?' they said yes."
"Conservative democrats are going to be attacked from the right on the mandates but what makes the mandates popular is the public option."