In 2007, Republican Senator Jim DeMint of South Carolina sent a letter to President George W. Bush.

DeMint said he would like to work with Bush to pass legislation that would “ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.”

Read that closely. DeMint does not say he wants legislation that would ensure all Americans have “access” to coverage — the standard rhetorical dodge of politicians who don’t want to oppose universal coverage, but also don’t want to do what’s necessary to achieve it. He says that he wants legislation that ensures all American actually have coverage. He says that without making sure every American has coverage, “the health care system cannot be fixed.” For good measure, DeMint wants to achieve this “while protecting current government programs.”

DeMint was not alone. Signatories to the letter included Democratic Senators Maria Cantwell, Kent Conrad, Herb Kohl, Ken Salazar and Ron Wyden, and Republican Senators Robert Bennett, Mike Crapo, Trent Lott and John Thune. But it’s DeMint’s involvement that seems, in retrospect, most remarkable.

Conservative Champion

DeMint is arguably the Senate’s most conservative member, and he’s inarguably the chamber’s most aggressive champion of the Tea Party. He’s the guy, in fact, who has been helping the Tea Party knock off Republican incumbents for being insufficiently conservative. Yet in the letter to Bush, DeMint sounds like Barack Obama. That letter wasn’t an isolated incident. DeMint also endorsed Mitt Romney for president in 2007, telling National Review that Romney “has demonstrated, when he stepped into government in a very difficult state, that he could work in a difficult partisan environment, take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured.”

Whatever the fallout from the Supreme Court decision on the Affordable Care Act, the two parties have clearly laid out their health-care platforms for 2012. The Democrats’ commitment is to provide every American with health insurance. The Republican Party’s commitment is to prevent any American from being forced to have health insurance.

It wasn’t always this way. Democrats and Republicans used to argue over how best to achieve universal coverage, but both agreed on the goal. The first president to propose a serious universal health-care plan was Harry Truman, a Democrat. The second was Richard Nixon, a Republican. In the 1990s, when President Bill Clinton was arguing for a national health-care system based on an employer mandate, Republicans were arguing for one based on an individual mandate.

In the 2000s, Romney used the individual mandate to make Massachusetts the first state to actually achieve near-universal coverage. On the national level, Republicans as diverse as Newt Gingrich, Lamar Alexander and Lott joined him. Republicans sometimes like to present their support for the individual mandate as a youthful indiscretion, but as late as June 2009, Charles Grassley, the ranking Republican on the Senate Finance Committee, was telling Fox News that “there is a bipartisan consensus to have an individual mandate.”

Reduced Coverage

Today, Romney touts a health-care plan, to the extent he has one, that would almost certainly lead to reduced insurance coverage. He wants to repeal the Affordable Care Act, cutting loose 31 million Americans who are expected to gain coverage under the law. Then he wants to drastically cut Medicaid spending by turning it over to the states and capping the growth of federal contributions. The Urban Institute estimates that such a policy would cause 14 million to 19 million Americans to lose Medicaid coverage.

This, perhaps, is one of the clearest differences between the Republicans and Democrats in this election: health insurance for 45 million to 50 million people.

It’s still possible that Romney will devise additional policies to offset, at least partially, the loss of coverage. Right now, he promises to “end tax discrimination against the individual purchase of insurance,” a pledge too vague to analyze. By this time in 2008, presidential candidates Obama and John McCain had both detailed health-care proposals loaded down with specifics. Romney’s lack of detail, or even a general outline, confirms how little pressure Republican primary voters put on him to address the issue.

In part, this is because the Republican Party continues to be in opposition mode. Having jettisoned their support for the individual mandate in order to fight a Democratic bill with the mandate at its core, Republicans simply have no policies that could plausibly lead to universal coverage. Instead, they’ve moved in the opposite direction, vowing to reduce spending on government programs. One unfortunate consequence of cutting spending that goes toward health insurance for poor people is that fewer poor people have health insurance.

Indeed, influential conservatives have been turning on the idea of universal coverage entirely. In June 2007, National Review published an editorial arguing that Republicans should reject “the goal of universal coverage. Deregulating health insurance would make it more affordable, and thus increase the number of Americans with coverage. But to achieve universal coverage would require either having the government provide it to everyone or forcing everyone to buy it.” Michael Cannon, director of health-care policy at the libertarian Cato Institute, formed the “Anti-Universal Coverage Club,” whose members “reject the idea that government should ensure that all individuals have health insurance.” This attitude is now the norm within the Republican Party, even if it is rarely acknowledged so starkly.

The battle over the Affordable Care Act has largely distracted voters from this tectonic shift in the Republican Party. Yet unlike in past elections, in which even the most conservative Republicans argued that we should “ensure that all Americans would have affordable, quality, private health coverage,” voters this year will choose between one party that supports universal health care and one that doesn’t, with health insurance for as many as 50 million voters hanging in the balance.

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