Who Really Killed Utah's Healthcare Mandate?

WASHINGTON -- Former Utah Governor and GOP presidential hopeful Jon Huntsman Jr. wants you to know he hates mandates. In fact, he claims at the very least to have given the cold shoulder to any attempt to include one in his state's 2008 health care reform legislation.

It's a narrative that the former governor pushed during his inaugural glad-handing trek through New Hampshire in May. "I didn't push mandates with the legislature. You want to get that right," he told HuffPost.

Huntsman later elaborated on his role as mandate killer. "You've got to live with the idea of what mandates will do, how people will respond, the benefits or burdens to small business," he said. "And after you argue it with all the experts, then you've got to come up with what you think is the best solution." Huntsman went on to say that he felt mandates are "an unnecessary burden on individuals and on businesses."

But as The Huffington Post has previously reported, Huntsman had favored the individual mandate as early as 2005. The mandate continued to hold currency within his administration for years, and HuffPost has learned the mandate was included in the 2007 draft of the legislation that created Utah's health care reform.

"If we were going to make a successful run at health care reform then everyone had to participate," said State Sen. Gene Davis (D), who serves on the legislature's health care reform task force. "The only way to make that happen is through a mandate. He recognized it. There's going to have to be a mandate."

Davis recalled being aware of the draft bill and said there were discussions that included the mandate idea. "I had discussions about a mandate at that time," he said.

State Sen. Peter Knudson (R), the assistant majority whip who serves on the legislature's health-care reform task force, had a similar recollection of the original bill. Was a mandate included? "Yeah, there was ... We were thinking in terms of making sure there was a health care package affordable to all and we felt perhaps the best way to do that at the time was to include a requirement that it be utilized by all. It was a trial balloon and it didn't fly."

The trial balloon was floated in a Salt Lake Tribune story on Dec. 8, 2007:

"Utah is moving toward a consumer-driven health care system -- which means, as in Massachusetts, residents would take responsibility for buying their own health insurance. The bottom line: Eventually, every Utahn would have to be insured, according to a confidential working draft of Gov. Jon Huntsman Jr.'s three-year plan to retool the state's health system."

Pursuing higher education? You may have to get health insurance before you would be allowed to register for classes.

Unemployed? You might have to get at least a minimal level of health insurance in order to get a job. Once hired, your boss would verify your insurance status -- and check it every quarter."

The Tribune went on to report that the Nov. 28 draft focused on three groups of Utah residents -- including people who did not have insurance but could afford it. The plan would have stipulated that "this group would have to get insurance or face obstacles, possibly in enrolling in university classes or getting a job," the Tribune reported.

The draft bill was circulated among the governor's top advisers and prominent community advocates.

John T. Nielsen, Huntsman's adviser on health care reform, pushed the bill in the Tribune piece suggesting that there might be a tax penalty for those that do not purchase insurance. "I think there are going to be some who view that as oppressive and interfering with personal choice and personal liberties," he told the paper. "But one person does affect another person. The people who simply choose to ignore their personal responsibility -- everyone else has to pay for that."

Nielsen told The Huffington Post that the bill was modeled after Mitt Romney's Massachusetts Connecter plan. "The original early, early iterations of health reform were an attempt to replicate what Massachusetts had done," he explained. "We drafted a bill that looked something like what Massachusetts did that included a mandate. It was just a draft. It was never numbered ... It was a discussion piece."

By the time the health-care reform bill was made public, the mandate was gone. So who really killed Utah's health care mandate?

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Like any good detectives, HuffPost started from the outside and worked its way inward towards a possible suspect. We first talked to the not-so-helpful bystanders.

"I don't recall the mandate," replied Rep. Bradley Daw (R), a former task-force member. "If there were calls for a mandate, it never really made it too far down the road. This is what I believe: You had some advocacy groups that were pushing very hard for a mandate. There's every chance that that found its way into an early draft as a sort of discussion point."

Daw thought the bill's sponsor, Rep. David Clark, could have killed the mandate. So did Rep. David Litvack (D), the minority leader. "My feelings at the time was that the sponsor, Rep. Clark, that he really made the decision not to have the individual mandate there because of the dynamics of the legislature."

Clark, though, refused to confess to killing the mandate. He said that there was simply an anti-mandate consensus among the legislative leadership. Of the mandate: "From a legislative perspective there was no appetite," he said.

After a week of interviews, no one ever mentioned Huntsman as the guy who actually took the mandate off the table. In fact, only one name other than Clark came up -- an insurance industry veteran and state Republican Rep. James Dunnigan.

Dunnigan remembered sitting in a meeting when the mandate was proposed. He couldn't believe it: "I turned to a legislator [and said], 'Are you serious? In Utah? They're talking about a mandate?' "

HuffPost asked Dunnigan whether he was responsible for getting rid of the provision. "OK. I was not a proponent of that for sure," Dunnigan said. "I did comment to some of the people that you have named there: 'I was not ready for that.' I said, 'No.' Furthermore, I said I don't see this getting passed the legislature."

"I was shocked," Dunnigan continued. "Utah is supposed to be a free market, independent state. And we're talking about a mandate? I thought I was in Utah. I didn't think I was in Washington, D.C."

One of the people Dunnigan met with was Nielsen from Huntsman's office. Nielsen confirmed meeting with Dunnigan and others. Nielsen said he didn't think he had a chance of convincing the legislature to support a mandate. Dunnigan and Co. made that crystal clear. "Absolutely never going to happen," Nielsen said Dunnigan told him.

While the mandate has become a harsh early litmus test for GOP presidential hopefuls, history yields messy outcomes. Huntsman can say that he signed a law that created a health care exchange that did not include a mandate. But he also never stepped up and killed the idea. The mandate, after all, had been championed by conservatives, including the Heritage Foundation and his own administration. For a state with 300,000 uninsured residents, a mandate was a tempting, credible fix.

In fact, the bill that Huntsman signed required that the state continue to study the mandate. It has been discussed during health care task force meetings. Rep. Litvack even says the mandate in Utah isn't really dead.

"I don't think the mandate question has been resolved -- whether we as a state will be able to succeed without it," he said. "I think people are avoiding it. I don't think it has been definitively dismissed."