Force yes, but she wants it affordable

In a debate the week before primaries in Texas and Ohio, Sen. Hillary Clinton and Sen. Barack Obama argued yet again over their health care plans. Clinton charged Obama with distorting her health care plan in a mailer, while Obama stuck by its claims.

The mailer states in part: "The way Hillary Clinton's health care plan covers everyone is to have the government force uninsured people to buy insurance, even if they can't afford it." Clinton said that wasn't an accurate description of her plan.

"It's been unfortunate that Senator Obama has consistently said that I would force people to have health care whether they could afford it or not," Clinton said, adding "my plan will cover everyone and it will be affordable."

But Obama defended the mailer, saying that it "accurately indicates that the main difference between Senator Clinton's plan and mine is the fact that she would force in some fashion individuals to purchase health care."

"If it was not affordable, she would still presumably force them to have it, unless there is a hardship exemption as they've done in Massachusetts, which leaves 20 percent of the uninsured out. And if that's the case, then, in fact, her claim that she covers everybody is not accurate."

When candidates talk about universal health care plans, they usually mean that every person in the country will be covered. Clinton's plan achieves that with an individual mandate, requiring every person in the country to either have insurance or buy it. Obama's plan does not have a similar mechanism, and Clinton regularly criticizes him for it.

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Clinton's plan also has several strategies for lowering costs so that insurance is affordable. (Many of these strategies are similar to Obama's plan.) She wants to expand Medicare and the Children's Health Insurance Program and seeks to limit premiums that people pay to a certain percentage of their income.

Obama's argument is that there will be some people who don't get health insurance through work but who make too much money to qualify for special programs. If those people don't buy their own insurance, they will be fined, and that's punitive, according to Obama.

Clinton said during the debate that that won't happen because her plan has enough subsidies to make sure insurance is affordable for all. Her implicit argument is that there won't be any people who can't afford coverage or who don't qualify for a free or low-cost plan.

A big part of this mandate debate hinges on future events: Can Clinton's health care plan lower costs enough so that even low-wage workers pay only a reasonable portion of their income for coverage? The experts we've talked to say a lot will depend on what the actual legislation looks like, and clearly that's a future event.

Right now, though, Obama's characterization of Clinton's plan seems too reductive. Yes, it does "force" people to buy insurance in the sense that a mandate requires everyone to be covered. But her plan's intention clearly is that everyone will be able to afford it. Obama's mailer makes it sound like Clinton's plan is a ham-handed law, and that Clinton isn't concerned with cost. So we can't completely agree that Obama's mailer is accurate. We rate his statement to be Half True.