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On Twitter, Politico's Ben Smith asks, "At this point, how is current proposal substantially different from Romneycare?"

The answer is, it ain't.

Here's how Mitt Romney explained the differences between the health care bill he signed in Massachusetts in 2006, and Obamacare, in a CNN interview earlier this month:

(T)here's an important difference between what we did and what President Barack Obama is proposing. Number one, we solved our problem at the state level. Let states deal with the problem of uninsured individuals.

And, number two, we have no public option. There's no government option. And what's primarily wrong with the president's plan is that he wants to get the federal government into the health insurance business. It's going to require massive subsidies, a trillion dollars of costs down the road.

Though we haven't seen the current bill yet, if reports are accurate, it does not contain a public option or Medicare expansion. What remains is a Medicaid expansion, a mandate forcing individuals to purchase insurance or pay a tax, and sliding scale subsidies for individuals to purchase government-designed insurance policies on new government-run exchanges -- and those elements formed the core of Romneycare.

So now, if Obamacare passes, Romney will be left telling angry primary voters that the only real difference between the two plans is that he implemented his policies at the state level, while Obama did it through the federal government. Sure, it's clearly worse if the federal government is implementing bad policies, but it's hard to see how such an argument would pass muster with anybody but those who are already ardent Romney supporters. It's sort of like saying, "As governor, I raised state income taxes, but the thought of raising federal income taxes -- that's an outrage!" 

UPDATE: Romney spokesman Eric Fehrnstrom emails Ben Smith:

There are some similarities. For instance, the concept of the "exchange" where people can shop for affordable health plans was pioneered in Massachachusetts. But Mitt's Romney's health care reforms are different in several important respects. First, the bill signed by Governor Romney did not raise taxes. Second, its focus was on strengthening the private insurance market, and I don't think anyone believes that Democrats have given up on their dream of a public option. And finally, Governor Romney believes states should be free to come up with their own approach instead of having Washington create a "one-size-fits-all" solution for the entire country.

This answer is problematic on several levels. For one thing, while the Romney camp would like to argue that the bill he signed did not raise taxes, in actuality, it did include a mandate that individuals purchase insurance or pay a penalty. In arguing against Obamacare, conservatives have described the mandate as a middle class tax hike. Republican candidates will spend all of 2010 describing it as such, and if anybody else were running against Obama in 2012, it would be used to argue that he violated his pledge to not raise the taxes of those making under $250,000. If Romney wants to spend the Republican presidential primary siding with Democrats and the Obama administration in arguing that the individual mandate isn't a tax, I'm sure his opponents will be thrilled. Furthermore, this doesn't even take into account the subsequent tax hikes signed by Romney's successor to help pay for the ongoing costs of the health care bill, such as last year's cigarette tax increase.

Fehrnstrom argues that the Romney plan was about strengthening private insurance, and yet, just as the government dictates the design of private health care policies offered on the exchanges created by the Senate bill, so too, does Romneycare. In Massachusetts, the Commonwealth Health Insurance Connector's Board approves plans offered in the exchange, and determines what counts as "Minimum Creditable Coverage" needed to comply with the insurance mandate.

I responded to the whole attempt to differentiate between federal and state policy above, but as Smith notes, "in the end, Romney does seem to have helped set the model for the national plan."

View all comments (11) | Leave a comment

TomH| 12.15.09 @ 3:21PM

Phil:

Oh Mr. Kelin, you still don't get it. Angry voters were angry about the public option and medicare expansion.

And, as you say, "Obamacare does not contain a public option or Medicare expansion"

Did you see that Klein? The anger that voters had just evaporated.

Health votes are about health care reform. A majority of Americans see this as Health care reform and want it.

Romney is going to need Democrats to win the next Presidential election and he'll have a friend in Democrats if they know how he knows how to speak "health care reform" and isn't an enemy to it.

This one is going to bite you in the behind Klein.

You're wrong on this one.

Rank and File| 12.15.09 @ 3:23PM

It does pose some challenges for Romney, ideologically, but the "state level" argument isn't insignificant. It's sort of everything. States should be able to support their own policies -- well or ill-advised. That's is carved into the bedrock of Conservatism.

Moreover, the public-option is about as far from the shores of the current bill as the high tide from the low tide. If the floodwaters of Reid/Pelosi/Obama health care get inked into law, the high-tide of the government option will find its way in.

TomH| 12.15.09 @ 3:58PM

Republicans need to do a better job on this issue.

So far, Democracts know more about health costs and are trying to address it whilst Republicans are crying "socialized medicine."

In the US. total health care spending was 2.4 trillion or about $7,900 per person!

That figure is 50% MORE than the next most costly nation and that's Norway.

The ONLY reasonable or rational objection to Obama's health care plan was the public option.

But, according to Philip Klein, the public option is most likely out.

Republicans have made their own proposals but they don't address the COST of skyrocketing health care.

Where are the Republican innovators who dare to tackle this issue?

Chris Bolts Sr.| 12.15.09 @ 4:55PM

If Democrats are doing something about costs, TomH, why in the world are they doing anything, ANYTHING to get to 60 votes? That doesn't sound like controlling costs to me.

Oh, and about that cost thing, the Medicare actuary already said it ain't going to do anything to lower costs and will more than likely exacerbate cost increases. No one makes that argument anymore these days.

Ken (Old Texican)| 12.15.09 @ 6:39PM

Nothing new here.

Fed programs are DESTINED to balloon over budget.
That is how they kill people.

Harrison| 12.15.09 @ 8:21PM

Romney took on the job of Governor of MA to help that state climb out of the bankrupt pit it was sliding into. A significant factor of the MA plummet uninsured residents getting medical care and not paying for it. The taxpayers were stuck paying the bills and were fed up with it.

Romney put together a plan that freed taxpayers from paying someone else's medical bills and placed the responsibility for medical care back on individuals' shoulders. His plan involved NO money from taxpayers; it was privately funded. His compassionate approach to the sick also enabled the uninsured to purchase affordable health care coverage. The Dem controlled legislature added to/changed the bill somewhat to include monies of 1% of MA's annual budget. Currently, the health care plan in MA is operating on budget. The residents of MA have health care coverage.

Remember, Romney took on this problem when health care wasn't in the public eye as it is now. He worked to solve a complicated, difficult problem, pretty much on his own.

Ashton| 12.15.09 @ 8:46PM

If Obamacare passes in 2010 and becomes law, it would take healthcare as an issue off the table for 2012.

Even if the plan the President signs ultimately ends up like the one Romney adopted in Massachusetts, I would think that would benefit Romney because a divisive issue that would otherwise linger into the next Republican primary would effectively be settled.

I would think it hurts Romney more if no deal is reached and nationalized healthcare remains a hotly debated issue for another election cycle.

Frank| 12.15.09 @ 9:19PM

Romney's bill doesn't cut Medicare by 500 billion dollars.

It also doesn't cost a trillion dollars.

The people of Massachusetts like the Romney health care reforms, even if some outside groups do not. States should be free to come up with their own healthcare solutions.

While it's true the Democrats in Massachusetts raised taxes after Romney left, that can hardly be blamed on Romney. That's what Democrats do - raise taxes. They're raised the cigarette tax, the sales tax, the meals tax, the hotel tax, the tax on alcohol, business taxes, and taxes on utilities. If anything, what this tax-raising demonstrates is how important it was to have an anti-tax Republican like Romney in the Governor's office.

Stephen Thomas| 12.16.09 @ 12:36AM

Wanted to thank all whom have spoken so intelligently in support of Gov. Romney's Healthcare plan and economic record in Mass. I often worry that the "facts" are ever increasingly the second greatest casualty this nation faces. Keep up the good work for in a commitment to what is factual you all give me hope.

BOSMAN| 12.16.09 @ 10:18AM

I own a mid-sized business in MA. When Romney was Gov, My taxes went down and my employees premiums went down as well. Romney didn't stay long enough to tweak out any unforeseen problems. He vetoed the goodies that the MA legislature added LATER under Governor Patrick. The supposed problems with Romney's health care program in MA are attributable to the changes made by the new governor - who has bloated it, over-regulated it and applied it to illegals. The cost of Romney care is less than 1.3% of the States budget. Patrick has chosen not to make Healthcare a Priority. If he would, the 1.3%, would be even less. Ma fiscal problems are a result of Patrick. He spends money like a kid in a candy store. In addition, Romney has stated that Individual states should determine health care issues in their states. This should not be mandated by Washington. a study was done recently shows that MA RESIDENTS still like the system. It seems MA HEALTH CARES biggest critics, DON'T LIVE IN MA!

ROMNEY / DeMINT in 2012!

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