WASHINGTON -- Embarking on a lengthy swing through the critical caucus state of Iowa, newly minted presidential candidate Newt Gingrich is already refining his health care pitch.
The former House Speaker is already walking back comments made on Monday in which he called a plan by House Budget Committee Chairman Paul Ryan (R-Wis.) to turn Medicare into a voucher program “radical ... right-wing social engineering.”
"There is little daylight between Ryan and Gingrich," Rick Tyler, a spokesman for Gingrich, wrote in an email to The Weekly Standard. "But look how it gets reported. Newt would fully support Ryan if it were not compulsory. We need to design a better system that people will voluntarily move to. That is a major difference in design but not substance."
Gingrich is also expected to denounce the idea of an individual mandate requiring people to buy health care coverage, a provision that he has touted -- in various forms -- for several years as a critical component of reform.
According to a campaign advisory sent to reporters Sunday night, Gingrich “will emphasize his opposition to a federal individual mandate for health insurance as imposed by the Obama administration. He will also reiterate his call for the complete repeal of Obamacare. But he will also attest, as most Americans would, that everyone must take personal responsibility for their own health care costs.”
There are, to be sure, several ways to compel individuals to pay for their own health care costs without requiring them to purchase insurance. The Government Accountability Office, an investigative arm of Congress, released a study in March 2011 on the possible alternatives, settling on nine options:
• Modify open enrollment periods and impose late enrollment penalties.
• Expand employers’ roles in auto-enrolling and facilitating employees’ health insurance enrollment.
• Conduct a public education and outreach campaign.
• Provide broad access to personalized assistance for health coverage enrollment.
• Impose a tax to pay for uncompensated care.
• Allow greater variation in premium rates based on enrollee age.
• Condition the receipt of certain government services upon proof of health insurance coverage.
• Use health insurance agents and brokers differently.
• Require or encourage credit rating agencies to use health insurance status as a factor in determining credit ratings.
Achieving near-universal coverage under any of these alternate approaches, the GAO emphasized, was dependent on having high-quality affordable care readily available for consumers. Even then, there was not complete certainty that the “impact would be significant or comparable to that of an individual mandate.” A single payer approach or even a public option was not part of the study.
Gingrich certainly has weighed these alternatives as well. He has written extensively on health care reform and, during the mid-2000s, came to the conclusion that “we should insist that everyone above a certain level buy coverage (or, if they are opposed to insurance, post a bond). Meanwhile, we should provide tax credits or subsidize private insurance for the poor."
Requiring individuals to buy insurance or post a bond is philosophically similar (if not the same) as a mandate. And according to contemporaneous news reports, Gingrich did, at one point in time, think that variations of this could be instituted at the federal level. It was primarily when President Barack Obama incorporated the idea into his own legislation that conservative support for it soured.
Gingrich isn’t the only GOP candidate backing away from the mandate. But he may be moving away the quickest. In a high-profile speech last week, former Massachusetts Gov. Mitt Romney argued that the mandate made for fine policy in his home state. Applied nationally, however, he said it made for a massive, unconstitutional, government overreach.
Tyler, Gingrich's spokesman, said there were no prepared remarks for the Iowa tour and that Gingrich would be speaking extemporaneously.
UPDATE: Gingrich's campaign has now put out a video in which the former Speaker declares that he is "completely opposed to Obamacare's mandate on individuals."