This article first appeared in the St. Louis Beacon, Feb. 9, 2011 - WASHINGTON - Last week, U.S. Sen. Claire McCaskill, D-Mo., said she and a few other senators were looking at whether it might be possible to alter the health-care overhaul's individual insurance mandate in a way that would preserve the program and allow it to cover people with pre-existing medical conditions.
"We are exploring whether it is possible to get enough more people in the pool by limiting the enrollment time and having significant financial penalties if you don't sign up during the enrollment time," she said at the press conference in the Capitol.
That comment and a similar quote in an article Tuesday in Politico spurred the Missouri senator's critics to allege that she was waffling on her previous support for the mandate -- a keystone provision of the health-care overhaul whose constitutionality has been challenged by two federal district court rulings.
The National Republican Senatorial Committee -- which regularly criticizes Democratic senators up for re-election -- issued a news release Tuesday accusing McCaskill of "attempting to backtrack on her strong support for ObamaCare's costly, unpopular individual mandate." And Lloyd Smith, executive director of the Missouri Republican Party, noting that McCaskill had voted to keep the mandate in the health care bill last year, charged in a statement Tuesday that the senator's "sudden election-cycle repentance is too little, too late."
Republicans made similar allegations after MSNBC quoted McCaskill last month on her willingness to explore options to the mandate.
She also is taking hits from liberals as well. On MSNBC's "Rachel Maddow Show'' Tuesday night, Maddow asserted that McCaskill was risking the same fate as now-ex U.S. Sen. Blanche Lincoln, D-Ark., who sought to portray herself as a conservative at odds with her own party. Maddow warned of defections from Democratic voters, and placed a giant cutout of Lincoln in a giant envelope "addressed'' to McCaskill.
McCaskill and her staffers say that her position has not changed: She supported the health-care overhaul with the mandate (and voted last week against a Republican amendment to repeal the health-care law), but is open to considering alternatives if they also guarantee that insurance companies would be required to insure people with pre-existing medical conditions -- a popular provision of the new law.
"The most popular part of the bill requires the least popular part of the bill," McCaskill told the Beacon and a small group of other reporters in the Capitol last week. "So [politicians] who aren't being responsible are pretending to the American people that we could do one without the other. And it's very hard."
Last week, McCaskill confirmed that she was talking with a few senators, including Sen. Ben Nelson, D-Neb., to see if there might be a workable way to allow some people to opt out of the health-insurance mandate if they pay a penalty. "We're trying to maintain a private, free-market system and still cover people that are clearly risks in that private market."
On Tuesday, Politico quoted McCaskill saying she and other senators were "looking at different ways to try to" extend coverage without a mandate. "We're running numbers to see how many new people we can get into the pool with something less than a mandate, something that would be more limited enrollment periods with severe financial penalties for not signing up." McCaskill added that an alternative "may not be workable; it may be that the mandate is the only way we can do it. But I think we should explore it."
Asked last week if she and other senators were close to a solution, McCaskill said: "Nothing's really jelled. We're just discussing it. What I've mostly done is just signal my willingness" to consider options. On Tuesday, a spokeswoman for McCaskill told the Beacon that the senator "hasn't signed on to any legislation at this point" related to the health mandate.
For his part, Nelson said in a statement that "we need to improve the [health care] law, not throw it out." He has asked both the Congressional Budget Office and the Government Accountability Office to examine alternatives to the mandate, perhaps by using enrollment periods and penalties to attract large numbers of people to sign up voluntarily for medical insurance. "This is about making it better," Nelson told Politico. "I never thought the mandate was a particularly good way to do it."
Other than Nelson, the other senator known to be involved in the discussions is Sen. Joe Manchin, D-W.Va., who -- like McCaskill and Nelson -- voted against repeal of the health-care overhaul. After the vote, Manchin said in a statement that "we should next work on commonsense legislative options to repair the individual mandate."
On Tuesday, Manchin told ABC News that "we're looking at everything humanly possible" to find an alternative to the mandate that would also require coverage for people with pre-existing conditions. "I've always had a concern and a problem with the mandate, that we were forcing it, basically saying by the law of the land you have to buy the product. But on the other hand, I know that's been the lynchpin. I'm looking for flexibility any way I can."
McCaskill Explains Her Position
In the discussion with reporters in the Capitol last week, McCaskill explained the difficulties of coming up with a solution other than the mandate.
"When you want to make sure we cover people that have been sick before, and you want to maintain private insurance in this country, that's really hard," she said. "The only way ... is to make sure more people are in that market."
Noting that some critics say they want to eliminate the mandate but still require insurance companies to cover pre-existing conditions, McCaskill said: "Well, exactly how do you do that? And none of them can answer that question."
At the news conference, McCaskill suggested that a possible solution might end up being "similar to Medicare D" -- the prescription drug plan, added to Medicare, that requires people to pay a penalty unless they enroll in the plan during a time window.
"What happens now is there are many seniors that don't have many prescriptions (and) that sign up for Medicare D because they are afraid they might need it next year. So the issue is: Will the research support that approach as workable to still allow us to cover people with pre-existing conditions?"
McCaskill said most critics of the health-care overhaul are unrealistic about how it might be improved. "It is la-la land for people around here to say, 'Oh, we're going to replace it, but we're still going to make sure people with pre-existing conditions can get insurance.' Well, they're not going to do that unless they have a government-run system," she said.
"It would be like telling people: You can go get car insurance after you have a wreck. Can you imagine how expensive car insurance would be if the only people buying car insurance were people who've already wrecked their car?"
McCaskill said "making this bill better should not be a 'gotcha' moment. That's the irony here. It's almost as if the other side doesn't want to get it repealed and doesn't want it to get fixed because they are so intent upon this being the only thing that they win elections with. No wonder the American people think we've all lost our minds out here.
"Rather than fix it, [critics] would rather use it as a political sledgehammer. Well, I'm not afraid of saying I'm willing to do it differently. None of us should be afraid to say that."