Even though Mitt Romney has had a string of primary wins,
support for his presidential bid still is tepid among Republican
voters nervous about Romneycare. He could calm them if he were to
more fully explain the difference between his vision for reform and
the
law that ultimately was enacted in
Massachusetts.
Gov. Romney gets big applause when he pledges to repeal
Obamacare, but he faces silence when he tries to defend Romneycare.
He insists, for example, that his individual mandate only impacted
the 8 percent of residents who were uninsured (the mandate covers
everyone), that he didn’t cut Medicare (states have no authority
over Medicare), and that he would issue a waiver to the states to
implement Obamacare their way (a president can’t undo an Act of
Congress with a waiver).
The voters are not reassured. Gov. Romney can get off the
defensive and change the subject by explaining that the
Massachusetts law which was passed by the overwhelmingly Democratic
legislature diverged significantly from his vision for reform, and
then describe what his reform plan would be as
president.
During the presidential debate in Jacksonville, Florida,
in late January, Romney took a small step in this direction when he
acknowledged that his successor, Gov. Deval Patrick, has taken a
much more liberal track in implementing Romneycare. “If I were
governor,” Romney said, “it would work a heck of a lot better.”
Indeed, when it passed the law, the legislature was counting on a
Democrat governor to succeed Romney to put the real regulatory
thumb screws in place.
The Massachusetts law is different in important ways from
the plan that Romney pushed as governor. Few voters know, for
example, that Romney strongly opposed the employer mandate and
wanted an escape from the individual mandate — allowing people to
instead be able to post a bond if they were uninsured and had big
medical bills. When Romney signed the law, he believed it contained
the escape hatch, but legislators removed it before final
passage.
Romney vetoed eight provisions of the Massachusetts bill,
and every one of his vetoes was overridden by the legislature.
Should Romney have known this was likely? Yes. Should he have known
exactly what he was signing? Absolutely. But voters may be more
forgiving if he tells them he wanted to give citizens and employers
a way out.
Why did he push Romneycare? The state was at risk of
losing $385 million in federal Medicaid money, and the Bush
administration insisted Massachusetts make changes to get more
residents covered and keep the money flowing.
Romney also wanted to find a way to make it easier for
small businesses and individuals to get insurance that would be
portable from job to job. To get around federal tax law
restrictions and to make health insurance portable, he adopted the
Heritage Foundation’s proposal to create exchanges that would allow
individuals to have portable insurance and pay premiums with
pre-tax dollars.
TODAY ROMNEY SAYS, “The market can work to solve our
health care needs.” The policy recommendations on his
campaign website
back up his perspective on patient-centered reform. But
primary voters aren’t. He needs to get off the defensive and take
charge of this issue.
Here’s a three-step plan:
Step 1: Focus on Repeal
of Obamacare.
Gov. Romney needs to get his message straight, or he will
be hammered in the general election over false promises. He calls
for repeal of Obamacare while saying he would immediately issue an
executive order to give flexibility to the states to implement the
law their way. That sets the stage to massively confuse the
political agenda: He would be sending the states off to begin to
implement Obamacare while Congress works in Washington to repeal
it.
Further, the Congressional Research Service issued a
report that said Obamacare’s major provisions are Acts of Congress,
and they simply cannot be changed through an executive
order.
His focus should be on repeal. Waivers to the
states from Obamacare are not a solution and, in fact, might well
detract from the ultimate goal of repealing the law and replacing
it with a genuine free market alternative. If Gov. Romney is
serious about repealing Obamacare, he will have to devote all of
his energies to doing that as soon as possible.
The House of Representatives passed a repeal bill a few
weeks after Republicans took control last year. In the Senate, many
parts of Obamacare could be repealed through reconciliation with
only 51 votes should Republicans take control there, allowing them
to enact legislation repealing the spending provisions that are the
biggest threat to the economy and to the federal
deficit.
He also could calm voters by emphasizing that a federal
mandate to purchase health insurance is unconstitutional and detail
more reasons why Obamacare’s government-centric approach is
wrong.
Step 2: Explain what
really happened with passage of Romneycare.
Gov. Romney’s support for states’ rights is important,
saying the law worked for Massachusetts but that other states need
their own solutions in our diverse and complex country. But
conservatives would feel better knowing what he initially proposed
in the Bay State. For example:
• Mandate escape. Few voters know that
Romney wanted an escape from the individual mandate. Voters may be
more forgiving if he were to tell them he wanted to give citizens a
way out and that he strongly opposed the employer
mandate.
• Real insurance. Romney wanted people to
be able to purchase real health insurance that would have covered
catastrophic events. Instead, the legislature insisted on including
all of the 50-plus health insurance mandates already on the books.
The legislature allowed the high-deductible plans only for some
young people aged 18-26.
After the Massachusetts law was passed by the legislature, Romney
continued to try to reshape it with his line-item veto. For
example:
• Employer mandate: Vetoed. The bill
called for a mandate on employers with 11 or more workers to
provide health coverage or pay an annual fee of $295 per worker.
Overridden.
• Covering certain immigrants: Vetoed.
The bill included a provision that would allow some non-citizens to
qualify for coverage under the new health plan.
Overridden.
• New bureaucracy: Vetoed. The bill
created a powerful new bureaucracy, called the Public Health
Council. Overridden.
• Limiting improvements to Medicaid:
Vetoed. The bill restricted changes to Medicaid to make the program
more efficient. Overridden.
Gov. Romney must clarify that in working with a Republican
Congress on a new health reform agenda, he would start with a very
different vision than Romneycare and work much harder to make sure
the consumer-friendly structure is what becomes law.
Step 3: Emphasize his
vision for market-based health reform, with a much clearer
description of what a President Romney’s plan would look
like.
He needs to talk about what he would do so he can stop
having to defend Romneycare. A handful of specifics would do, many
of which are included on his campaign website:
1) Help states set up functional pools so people with
pre-existing conditions are protected.
2) Provide new subsidies for the uninsured to purchase the
coverage of their choice.
3) Encourage the states to set up marketplaces for people
to buy insurance and allow policies to be purchased across state
lines.
4) Boost insurance rules to guarantee that if people have
coverage, they can keep it and their premiums won’t skyrocket if
they get sick, etc.
5) Move toward a system of tax credits and deductions to
allow individuals to buy and own portable health
insurance.
And regarding the “free-rider” problem Romney says that
the Massachusetts law was designed to stop: This can be addressed
without a mandate and in a way that is likely to be much more
effective. For example, if people don’t buy coverage with the
credit, then the credit could be used to automatically enroll them
in a private plan that would cover their major medical bills.
Properly structured incentives would be more effective than a
mandate in expanding coverage.
The health reform plan Gov. Romney pushed in Massachusetts
was different in key respects from the model that became Obamacare
but few people know the truth about Romneycare.
Unless Gov. Romney takes steps to clarify and remedy his
position, he will continue to have trouble convincing Republican
voters he is serious about repeal and will have an even harder time
mapping a clear plan on health reform should he be elected
president.
