When he stood up in Ann Arbor last week, Mitt Romney had a
problem. As a Republican presidential candidate, he supports
repealing the federal law signed by President Obama that forces
people to buy government-approved health insurance, expands
Medicaid, and offers subsidies to some individuals who purchase
insurance through government-run exchanges. As the governor of
Massachusetts, Romney signed a state law that does all of the
above.
“A lot of pundits around the nation are saying that I should
just stand up and say this whole thing was a mistake, that it was
just a boneheaded idea, that I should just admit it was a mistake
and walk away from it,” Romney said. “There’s only one problem with
that. It wouldn’t be honest.” Why? “I, in fact, did what I believed
was right for the people of my state.”
In a very business-like PowerPoint presentation, the
open-collared Romney then proceeded to demonstrate that he still
believes his Massachusetts health care law was right for the people
of his state. So why does he want to repeal a federal law based on
the same principles and that uses the same basic architecture?
Federalism, in a word. “Health care in Massachusetts may be
different than in Montana or Mississippi,” Romney said. “I’m
convinced, however, that the Obama administration fundamentally
doesn’t believe in that.”
The main difference between Obamacare and Romneycare, then, is
the level of government that implemented it. “Our plan was a state
solution to a state problem,” Romney added. “His is a power grab by
the federal government.”
Constitutionally, state governments retain powers not delegated
to the federal government. But even if this technical-sounding yet
important legal distinction could hold the public’s imagination in
an election-year fight over health care, the federalism argument
will not be sufficient for Romney.
Romney’s Massachusetts health care plan was designed in part by
experts who supported an individual mandate at the federal level.
(The state mandate, by the way, was a central component of Romney’s
original Massachusetts proposal. Although he initially preferred a
bond for people who chose to go without insurance, the mandate was
neither incidental to his health care plan nor entirely a creation
of the Democratic legislature.)
One was MIT economist Jonathan Gruber, who went on to help
devise the federal law signed by Obama. He subsequently
said Romney’s approach “gave birth” to Obama’s. “I’m a Dem
through and through,” Gruber told
Newsweek, “but Romney really knocked my socks off.”
Of course, Romney also drew from more conservative sources in
coming up with health care reform ideas. In his aptly titled new
book No Apologies, he writes, “The Heritage Foundation
helped us construct an exchange that would make individual premium
payments tax-advantaged, lowering costs even further.” But
Heritage’s Stuart Butler, who played a key role in developing the
exchanges concept, also supported a version of the individual
mandate at the federal level. In his 1993
lecture “Why Conservatives Need A National Health Plan,” Butler
argued, “The second element in our proposal is a requirement on
Americans to obtain at least a basic package of health care
insurance for themselves and their dependents.”
“[T]he insurance requirement is a protection for the rest of us
against those who would exploit our good nature, forcing us to
carry the risk that they should be responsible for as citizens in a
society,” Butler continued. “So our mandate is not designed to
micromanage people’s lives.” But it was a mandate to purchase
health insurance. Butler’s ideas influenced a 1993 bill introduced
by Sen. John Chafee (R-R.I.), who was authorized by then Senate
Minority Leader Bob Dole to come up with an official Republican
response to the Clinton health care plan. The Chafee
counterproposal contained a federal individual mandate.
Romney inadvertently highlights the fact that Republicans — and
even some conservatives — have in the past supported a federal
individual mandate, the main issue in constitutional challenges to
the national health care law. Romney even dropped hints that he
might have once been such a Republican. During his 1994 Senate race
against Ted Kennedy, Romney said he would vote for the Chafee bill,
albeit reluctantly. (Kennedy would later support Romneycare and be
present at the signing ceremony.) More recently, Romney has
repeatedly defended the concept of an individual mandate against
national critics.
“Some of my libertarian friends balk at what looks like an
individual mandate,” Romney wrote in an April 2006 Wall Street
Journal
op-ed. “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.” In a
February 2007 speech, Romney crowed, “If Massachusetts succeeds in
implementing it [the Romney health plan], then that will be a model
for the nation.” And in a January 2008 Republican presidential
debate, he argued, “[I]f somebody can afford insurance and decides
not to buy it, and then they get sick, they ought to pay their own
way, as opposed to expect the government to pay their way. And
that’s an American principle.”
In each of the above examples, Romney tiptoes up to the ledge on
the federal mandate but declines to take the plunge. Other
Republicans, however, were unambiguous in their support for the
individual mandate. This includes former House Speaker Newt
Gingrich, who apparently
still favors some form of mandate the federal level to this
very day. In fact, when Romney signed the Massachusetts mandate
into law, the AFL-CIO’s John Sweeney — then an opponent of
individual mandates — complained the governor was taking “a page
out of the Newt Gingrich playbook.”
Team Obama plans to use this history to drown out the federalism
argument and blur differences with Romney’s current federal health
care proposals. “We wholly endorse flexibility and we obviously
feel that Massachusetts took a smart approach towards health care
reform,”
said White House press secretary Jay Carney. “Its provenance
was so mainstream, there are great similarities between
Massachusetts’ law, the Affordable Care Act and legislation
proposed by then Rhode Island Republican [Senator] John Chafee in
1993.”
Carney also touted the federalism and flexibility allowed by the
waivers that can be granted to states under current federal law.
And don’t be surprised if they start pointing out that the federal
government pays 20 percent of the Massachusetts program’s costs
through Medicaid. Romney will not be able to counterpunch by
pointing to the fiscal costs, long medical wait times, and
emergency room crowding likely to take place under the Obama
policy, because the best real-world examples of this come from the
Massachusetts plan he continues to defend.
In addition to undermining the arguments for repeal, Romney
could also derail the Republicans’ plans for Medicare reform. House
Budget Committee Chairman Paul Ryan has proposed transforming
Medicare into a premium support system. Romney in Ann Arbor on his
Massachusetts health law: “We gave people a premium support program
where they could buy their own private insurance of their choice,
and for the poor, we helped them with support.” Washington
Post blogger Ezra Klein has already
argued that Ryan’s “plan basically turns Medicare into the
Affordable Care Act” signed by Obama.
To recap: what Mitt Romney did in Massachusetts may not raise
the same constitutional questions as what Barack Obama did
nationally. But many of the people who helped devise the
Massachusetts law had similar designs nationally. Romney is making
arguments about Massachusetts that are
nearly identical to what Obama has argued nationally, while
disqualifying himself from arguing for Obamacare’s repeal based on
Masscare’s failures. He is instead reminding people of the
individual mandate’s Republican pedigree at a time when arguments
against its constitutionality are gaining momentum. And he wants to
take credit for running a laboratory of democracy while denying his
experiments have any national consequences.
Maybe federalism can trump all that. More likely, conservatives
will agree with the
Wall Street Journal: “If [Romney] does not change his
message, he might as well try to knock off Joe Biden and get on the
Obama ticket.” And swing voters may channel Jon Gruber. “[Romney’s]
the one person who deserves the most credit for the national plan
we ended up with,” Gruber told Newsweek. “And yet he’s
railing against it. Does the guy believe in anything?”
Romney’s “no apologies” health care speech may have reinforced
the very reaction it was intended to avoid.
