HANCOCK, N.H. –- To hear Jon Huntsman and his advisers tell it, he is a bedrock conservative on health care who took a free market approach as governor of Utah that stands in stark contrast to plans approved by President Barack Obama on the national level and by Mitt Romney when he was governor of Massachusetts.
John Weaver, the top political aide to Huntsman in his exploration of a possible presidential bid, told The Huffington Post Friday that the Utah plan is "a clear alternative to Romney and Obama."
It's true that -- unlike Obama's and Romney's plans -- the bill Huntsman signed into law in 2008 did not include a mandate requiring health insurance or many rules compelling citizens to participate in the government-facilitated health plan exchange.
But it would have looked far different if Huntsman had his way, according to interviews with leading players in Utah politics. They said the former governor actually favored a mandate, but ran into fierce opposition from the conservative state legislature.
Huntsman disputed that version of events when asked about it on Friday. "I didn't push mandates with the legislature. You want to get that right," he said while stumping in New Hampshire.
Dr. David Sundwall, who was executive director of Utah's Department of Health under Huntsman, tells a different story. One month before the 2004 election, Huntsman invited Sundwall to his home to ask him to join his administration if he won the gubernatorial race. Sundwall said in an interview this week that he asked Huntsman what he wanted to do.
"He said, 'I'd like everyone in Utah to have health insurance. It's something that all of us long for. This business of the uninsured costs us a lot of money,'" Sundwall recounted. "It made sense to me."
Sundwall accepted the job. As soon as Huntsman was sworn in, the administration convened a group on health care to hash out a reform plan. They met for regular dinners at the house of a supporter who lived near the governor's residence. The group concluded, Sundwall said, that you couldn't do reform without a mandate.
The governor, he added, signed on to the idea. "He was supportive," Sundwall said. "It was something he would have liked to have happened."
But, he said, "we ran into a brick wall." The obstacle he referred to was Utah's Republican speaker of the House, Greg Curtis.
"I met with him in his office and he laid down the parameters," Sundwall recalled. "We pitched the idea of the mandate. And that was not going to fly, according to the speaker."
"We would have liked everyone to have had insurance. … And a mandate would have worked."
Judi Hilman, executive director of the nonpartisan Utah Health Policy Project, also hasn't forgotten Huntsman's support for requiring individuals to buy health insurance. "He did want the mandate. He certainly had advisers around him that understood none of this works without a mandate," she said.
Hilman could even remember the exact day -- May 3, 2005 -- when Huntsman organized a conference on health-care reform. One of the keynote speaker’s was Robert Moffit, a Heritage Foundation wonk and one of the key architects of Romney’s health reform. Another of the three keynote speakers was Dr. Joseph Jarvis, a physician and community leader who has long advocated in Utah for a single-payer style system.
Jarvis said in an interview that he ran into one of Huntsman's cabinet members prior to the conference.
"He said 'I know who you are. Governor Huntsman really likes what you say about health care reform,'" Jarvis said.
Hilman said the governor and some legislators were particularly enthralled with Romney's overhaul of his state's system. "His interest piqued when the Massachusetts reforms came together," Hilman explains. Huntsman and legislators "saw it as this product that came out of the Heritage Foundation. They really loved this idea,” he added.
Moffit, in an interview Friday, said he was less clear about where Huntsman stood at the time. He met with Huntsman briefly at a conference in Salt Lake City in 2005 convened by the then-governor to discuss potential approaches.
"He was not demonstrative in terms of having any specific ideas about where he wanted to go on this. If the question is, 'did he indicate any kind of clear direction at the time?' No he didn't," Moffit said.
But Sundwall, Moffit said, "was his chief guy." And Sundwall was vigorously pushing a mandate.
Local press reports from the time also reflect a different picture than the one Huntsman relates now, as he tries to win over the decidedly right-leaning Republican primary electorate.
Far from quickly dropping the idea of a mandate, Huntsman was "suggesting Utah should mandate health coverage for residents," according to a July 12, 2007, Salt Lake City Weekly piece.
An August 11 Salt Lake Tribune story described the governor's ambitious reform this way: "John T. Nielsen, who is working with the Governor’s Office in spearheading legislation for the plan, would mandate that all Utahn have health insurance through a nonprofit exchange that would facilitate the purchase of insurance."
In his 2007 state of the state address, Huntsman pressed for at least a mandate on insuring children. "In addition to the children, there are hundreds of thousands of uninsured adults," he said.
Huntsman called on the business community "to actively engage with advocates for the working poor as well as with health care providers and insurers to craft a solution for this growing crisis."
Soon, the United Way of Salt Lake City formed a committee comprised of high-profile business and civic leaders -- bankers, CEOs of large companies, Chamber of Commerce executives, and municipal bosses -- to come up with a reform plan of their own.
Huntsman sent along his encouragement and even lent staff support to the committee, said Bill Crim, senior vice president of community impact and public policy with the United Way of Salt Lake City. Crim served as the lead staff person on the committee.
"Governor Huntsman's staff was very much involved," confirmed Bruce Reese, the committee's co-chair. "We had really good involvement and monitoring from the governor's office."
Huntsman was still formulating his own plans, which would include a government subsidy to help the poor pay for insurance, and a mandate.
By the end of the summer of 2007, the committee, Crim said, came up with a framework for reform that married up with Huntsman's ideas. The United Way plan would include a health-insurance exchange similar to Romney's Connector and a mandate.
Three Utah officials involved with the reform effort said Huntsman fully endorsed the United Way plan.
"He was so enthused because he thought he had so many community leaders behind it," said Jarvis, who served on the committee. "He and his staff immediately tried to find sponsors for the legislation."
Jarvis adds that Huntsman went to the legislature and gave a presentation on the United Way plan. The sales pitch flopped.
"The resistance from the legislature was incredible," Jarvis said. "And he dropped it like a hot potato. … I get what he's up against. I have a hard time being severe with him."
Huntsman settled on the Utah Health Exchange, a mandate-less reform aimed at helping small businesses insure their employees. The Exchange does not include an individual market.
Sundwall explained it this way: "It’s like Travelocity. You get on and determine what benefits your family would need. The employer would contribute." Utah citizens then go on the Exchange and purchase from an array of private insurance plans. It began in earnest in 2010.
Weaver, Huntsman's top political adviser, said Friday that "at the end of the day, you're judged by what you do. And at the end of the day, he chose a free market health care approach."
"Just because you listened to the debate as the chief executive of the debate -- you had presentations made about all the options -- what is fundamental is that his belief in the free market system drove him to the current plan,” Weaver said in a brief interview.
And Huntsman defended his consideration of a mandate. "As governor, you've got to explore every approach, every policy option there is. You'd be disingenuous as a leader if you didn't," he said. "So when you're doing something as important as health care reform -- and something as important as closing the gap on the uninsured -- you've got to live with the idea of what mandates will do, how people will respond, the benefits or burdens to small businesses."
"And after you argue it with all the experts, then you've got to come up with what you think is the best solution." Ultimately, Huntsman said, he believes that mandates are "an unnecessary burden on individuals and on businesses."
But Huntsman's openness to a mandate -- if not an inclination for one -- shows that, had he governed a more liberal state like Massachusetts, he would likely be in the same position as Romney is currently in.
When Romney signed his health care plan into law in 2006, he saw it as a political victory. Now -- in large part because of the way that conservative concerns about the size and role of government have evolved -- Romney's health plan is his single biggest challenge to winning the GOP nomination.
"It's turning out to be one of the most unpopular features of the law. People don't want to be pushed around," said Moffit, who helped Romney design the plan and lent the Heritage Foundation's conservative imprimatur to the plan.
The other Republican presidential hopefuls -- Indiana Governor Mitch Daniels and former House Speaker Newt Gingrich of Georgia -- are also now facing the health care mandate litmus test.
Thursday, Daniels beat back assertions that he had once favored requiring individuals to purchase health insurance. And Gingrich wrote in 2008 that "everyone should be required to have coverage" by the government.
The mandate might not be popular, but reform in Utah without it has done little for the uninsured -- in stark contrast to Massachusetts. So far 114 small business have joined the Exchange; 1,035 employees have enrolled. Only 25 percent of those employees did not have insurance before the Exchange started. Utah, according to newspaper accounts, has roughly 300,000 uninsured residents.