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Mitt's Fight: Distinguishing "Obamacare" from "Romneycare"

Mitt's Fight: Distinguishing "Obamacare" from "Romneycare"

By Erin McPike - April 12, 2011

The irony for Mitt Romney on the thorny issue of health care is this: Although he appears to know more about it than even his toughest competitors, in all of the years he has been running for president, he hasn't been able to graduate to a place where he's able to show off that expertise.

When Romney launched his first presidential campaign in early 2007, the health care legislation he signed into law in Massachusetts the year before was the icing on the cake for his candidacy -- the big coup he pulled off that had eluded every other politician who had attempted it, including the front-runner for the whole 2008 shebang, one Hillary Rodham Clinton. But four years later, national health care reform is considered a poison pill for a huge swath of the Republican base.

In other words, Mitt Romney's biggest accomplishment as governor is now a huge liability -- so much so that he didn't even mention it in the video announcing the formation of his presidential exploratory committee on Monday.

Chief among his problems is that conservatives despise the individual mandate implemented in the state law he signed in Massachusetts, which was later applied to the nationwide law that President Obama signed in March of last year. Romney's book, "No Apology," underscores the delicate balancing act he has had to undertake in his public commentary about mandates, because by and large, he seems to oppose them in practice -- sort of.

"The original conception of the law was based on personal responsibility," an adviser to Romney's committee said of the Massachusetts reforms. "He thought individuals could make a decision about whether to carry their own insurance or demonstrate that they had sufficient financial resources to pay for their own health care."

Romney sought to base the Bay State's reforms on incentives rather than penalties where he could, and in so doing, implement a kind of soft mandate by offering an opt-out provision that would have allowed Massachusetts residents to pay for care rather than insurance if they were able. But he failed to convince Democrats in the state legislature to embrace this plan, and ended up with a bill requiring all Bay Staters to obtain health insurance.

Although, make no mistake: Gov. Romney did sign that bill -- and he defended, too. In a 2006 op-ed in the Wall Street Journal, he wrote: "Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian."

The national health care reform law dictates that those individuals who are financially able to purchase insurance but do not do so by 2016 will be fined a small portion of their income; Massachusetts began fining those who fit a similar classification starting in 2008 by charging them every month they did not carry coverage.

Today marks the fifth anniversary since Romney signed the bill, and Democrats are using the occasion to remind voters of his achievement. But the two-time Republican presidential hopeful changed the subject by actually becoming a candidate on Monday, when he filed his paperwork for a presidential exploratory committee with the FEC.

In the 2011 edition of Romney's book, a 27-page chapter, "Healing Health Care," is buried toward the back. The word "mandates" appears just twice, and both mentions refer to mandated coverage of health benefits that Romney opposed putting into the Massachusetts plan, rather than individual mandates to purchase coverage.

(Partial avoidance is not new to Romney: He uttered the word, "Mormon," just once in the major speech he gave on the freedom of religion on Dec. 6, 2007, in College Station, Texas, after a year of unyielding questions about his own faith prompted him to address it. Ten days later, Romney appeared on NBC's "Meet the Press" and moderator Tim Russert's first 14 questions dealt in some way with Romney's Mormon background.)

And now, Romney's latest riffing on health care has taken on a federalist tone. One thing that Team Romney is very quick to clarify is that he does not believe what he did in one state should be imposed on the entire country -- although it could be an example individual states could follow.

He notes in the book, "My own preference is to let each state fashion its own program to meet the distinct needs of its citizens. States could follow the Massachusetts model if they choose, or they could develop plans of their own." Two pages earlier he writes that he was able to obtain federal cooperation because his experiment could be a model for other states, but four pages later, he notes that from the beginning he warned that what worked in the Bay State might not work in California or Texas.

And so it is that Romney's opponents accuse him of wanting to have it both ways. His critics' question is: Precisely what does he think is good about the reform law he signed, and what wouldn't he want for other states?

"He obviously was very involved in the process and knows a lot about it, and that's why his vagueness is so galling," said an adviser to one of Romney's rivals for the nomination. "Which parts does he like for which states?"

South Carolina political consultant Richard Quinn, who would advise Jon Huntsman's presidential effort, put it this way: "Governor Romney keeps saying his health care program has some good parts that can be a model for other states. Which parts of government-run health care does he like? The unconstitutional mandates? Bringing an end to competition in health care? Higher taxes? Massive new government spending? I don't think South Carolina wants any part of that."

In his book, Romney does address three basic components of his plan that he likes: incentives through tax credits to those with insurance or reducing tax deductions for those without; an exchange that allows individuals to purchase coverage from a competitive grouping of insurers; and a sliding-scale government subsidy.

Still, rival Republican camps regularly float criticisms of Romney on health care whenever the chance arises, and a couple of them pounced last month when Romney wrote that he would sign an executive order on his first day in the White House to exempt each of the 50 states from the law Republicans invariably term "Obamacare."

Every time Romney mentions health care, it seems, he gets tweaked by a GOP rival or national Democrats. And by having delayed the formal announcement of his candidacy, Romney has not been in a position to do much about it. Nevertheless, it's obvious that Romney doesn't want to keep his mouth shut on this issue -- and it showed last weekend in a Las Vegas speech to the Republican Jewish Coalition.

He reminded his audience that Obama and his lieutenants incessantly point out that his plan inspired the national one. So in the event he would get to debate the president on health care, Romney fired away: "I'll say if that's the case, why didn't you call me? Why didn't you ask what was wrong?"

But his treatment of the differences between Obamacare and Romneycare are not always persuasive to his critics. In addition to the constitutionality issue, he complains that Obama's plan was more than 2,000 pages compared to the 70 that his was. Is that an argument that will sway movement conservatives? At another point he complains that Massachusetts Democrats spent a whole year changing the bill -- but that complaint seems at odds with conservative criticisms that the Obama administration and congressional Democrats rammed health care through Congress without sufficient opportunities to amend the bill.

Romney's book makes clear he has pored over data from state after state and studied program after program, so he obviously has a strong grasp of the details of this issue. Some Romney critics might also give him props for the eight vetoes he issued as governor to health care reforms he thought went too far -- vetoes that subsequently were overturned by the legislature.

The most noteworthy of those eight vetoes is his opposition to an employer mandate: Romney disagreed with "imposing a $295-per-person fee on businesses with 11 employees or more that do not provide health insurance," but he was overruled.

Two of the vetoes concern the creation of a public health council and the lengths of the terms each of its members serve, and several others were administrative in nature.

In "No Apology," Romney makes clear that his three big beefs with the current Massachusetts law are as follows: The lack of an opt-out provision for people who want to pay for care -- or the crux of the mandate; coverage mandates like in vitro fertilization and dental care for health plans; and the employer fee he tried to veto.

The Rockefeller Republican in Mitt Romney shines through in the section: Clamoring about personal responsibility, he's beside himself that the leader of "the new liberal administration," Deval Patrick, has let some citizens in the state obtain insurance for no cost at all -- because that, of course, incentivizes unhealthy people to move into the state.

Giving more circumspect treatment to the individual mandate, he writes, "I would also have rather provided a tax break for those who have health insurance rather than a tax penalty for those without health insurance."

At its core, Romney notes that his plan went a long way in addressing universal coverage, but not reducing costs -- it just didn't break the bank. Instead, he argues that what he proposed did not add anything to the state budget, whereas the changes Democrats made added just 1 percent.

Indeed, the Massachusetts Connector's website notes: "Massachusetts has the highest rate of insured residents in the nation, 98.1 percent. Reform has improved thousands of lives, and has only added 1 percent in new costs to the state budget, according to an independent analysis."

Romney picks that up in the book by noting, "But like all the measures that help to reduce health-care cost -- malpractice reform, electronic medical records, transparency, etc. -- achieving universal access alone cannot drive overall health-care costs for everyone to actually go down. That is the task that remains."

Some of his concluding thoughts about health care in the United States center on that subject. He cites the examples of Intermountain Healthcare in Utah and Idaho for establishing per-patient health care costs at one-third the national average and the Mayo Clinic in Minnesota and Arizona for similar reductions.

"Imagine a system in which an entity is paid a fixed amount to meet the health needs of an individual rather than being paid a fee for every activity that's carried out to meet those needs," he writes. "It may be possible for us to create a system in which we pay doctors and hospitals for what they do for a patient rather than what they do to a patient."

Erin McPike is a national political reporter for RealClearPolitics. She can be reached at emcpike@realclearpolitics.com. Follow her on Twitter @ErinMcPike.

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