Fact check: Coverage requirement enforced with tax

Memo to President Barack Obama: It's a tax.

Obama insisted this weekend on national television that requiring people to carry health insurance - and fining them if they don't - isn't the same thing as a tax increase. But the language of Democratic bills to revamp the nation's health care system doesn't quibble. Both the House bill and the Senate Finance Committee proposal clearly state that the fines would be a tax.

And the reason the fines are in the legislation is to enforce the coverage requirement.

"If you put something in the Internal Revenue Code, and you tell the IRS to collect it, I think that's a tax," said Clint Stretch, head of the tax policy group for Deloitte, a major accounting firm. "If you don't pay, the person who's going to come and get it is going to be from the IRS."

Democrats aren't the first to propose that individuals be required to carry health insurance and fined if they refuse. The conservative Heritage Foundation called for such a mandate in the 1990s' health care debate, although its proposal differed from the ones pending in Congress. Heritage has since dropped the idea and now favors using tax credits to encourage people to buy coverage - carrots and not sticks.

During the 2008 political campaign, Obama opposed making coverage mandatory because of the costs. His position has shifted now that it's becoming clear such a requirement will be part of any legislation that Congress sends him. Conservative activists are calling it a violation of his pledge not to raise taxes on the middle class.

"This is exactly what George Bush Sr. did when he said he wouldn't raise taxes, and it cost him the next election," said Grover Norquist, president of Americans for Tax Reform. "Obama is doing the same thing, but he's insulting people by telling them that if you don't call it a big purple banana, somehow it wouldn't be a tax."

Some liberals acknowledge that Obama might be vulnerable on the insurance requirement. But they say most people will understand as long as the legislation provides enough of a subsidy to make the coverage affordable. That's a central issue this week as the Senate Finance Committee starts voting on legislation.

"I think it's a metaphysical question as to whether it's a tax or not," said Roger Hickey, co-director of the Campaign for America's Future. "The real question that will determine whether people are upset is whether the insurance is affordable."

In an interview that aired Sunday on ABC's "This Week," Obama insisted that the insurance requirement is not a tax.

"For us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase," the president said. "What it's saying is...that we're not going to have other people carrying your burdens for you anymore.

"Right now everybody in America, just about, has to get auto insurance," Obama added. "Nobody considers that a tax increase.

"You just can't make up that language and decide that that's called a tax increase," he added.

But a Democratic staff description of Sen. Max Baucus' bill calls the proposed fines an "excise tax." Penalties of up to $950 for individuals and $3,800 for families would be imposed on those who don't get coverage. Sen. Kent Conrad, D-N.D., said Monday he expects the family penalty to be slashed in half to $1,900.

The House bill uses a complex formula to calculate the penalties, calling them a "tax on individuals without acceptable health care coverage."

The coverage mandate is part of a political bargain under which the insurance industry would agree to take all applicants, regardless of prior medical history.

"If we're going to have coverage without regard to pre-existing conditions, it makes sense," said economist Roberton Williams of the Tax Policy Center. "Otherwise people will come in the door the day they get sick." He sees no distinction between the requirement to get coverage and the fines themselves.

"The fact that it is imposed on people and they have no choice in paying it, and the fact that it's administered through the tax system all make it look like a tax," Williams said. The center is a joint venture of the Urban Institute and the Brookings Institution.

It wouldn't be the first asterisk added to Obama's campaign pledge on taxes. Earlier this year, he signed a tobacco tax increase to pay for children's health insurance. Even that can be read as a violation of his expansive campaign promise.

"I can make a firm pledge," he said in Dover, N.H., on Sept. 12, 2008. "Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."

He repeatedly promised "you will not see any of your taxes increase one single dime."