Former Massachusetts Gov. Mitt Romney's narrow win in the Iowa caucuses and his lead in the New Hampshire primary could catapult him to the GOP presidential nomination, but if he is to have any hope of gaining favor with conservative voters to get elected in November, he must escape the chains of Romneycare.
Romney has been unwilling to repudiate the health reform he signed into law in 2006, complete with the hugely unpopular individual mandate. The latest Associated Press-GfK poll shows only 15 percent of the American people think the government should have the power to require citizens to purchase health insurance or pay a fine.
That's what Obamacare will do -- barring a Supreme Court repudiation -- and that's what Romneycare already does.
In a November interview on Fox News, Romney got testy when anchor Bret Baier asked him, "Do you think a mandate, mandating people to buy insurance, is the right tool?" Romney replied, impatiently, "What we did in Massachusetts was right for Massachusetts. I've said that time and time again.… This is not a federal plan, it's a state plan."
Romney is stubbornly defensive about his universal coverage law, poking a finger in the eye of Republican voters who rightly see it as the platform for President Obama's takeover of health care. John McDonough, who helped design both Romneycare and then Obamacare, said the federal law is "Massachusetts with three more zeros."
Democratic pollster Patrick Caddell is among those insisting the health law will continue to be a huge issue in the 2012 election. Romney's defenses just aren't convincing, and as a result, voters distrust him on what he would do next in this crucial area. There is a way out of this box for Romney, but first, let's look at some examples of his current strategy and why it isn't working:
• Repeal and Replace -- with Romneycare? In the October 11, 2011 debate, Romney said: "…we all agree about repeal and replace. And I'm proud of the fact that I've put together a plan that says what I'm going to replace it with."
He says he wants to repeal and replace Obamacare, but then he says what he would replace it with is Romneycare! No wonder voters are worried. Does he really mean that he wants to use Massachusetts as a model for his "replacement" plan?
• Waivers for the states. Romney has said repeatedly that one of his first acts as president would be to "put out an executive order granting a waiver from Obamacare to all 50 states."
But Romney can't use an executive order to wipe out a massive new federal entitlement program and its huge taxpayer subsidies for health insurance, a vast expansion of Medicaid coverage, the Medicare rationing board, $550 billion in new and higher taxes, $575 billion in cuts to Medicare, and federal mandates on individuals, businesses, and the states to comply with the law. These are all part of the federal health overhaul law and simply cannot be waived by executive order.
The Congressional Research Service sent a letter to Sen. Coburn in November confirming this. "A President would not appear to be able to issue an executive order halting statutorily-required programs or mandatory appropriations… [or blocking] an agency from promulgating a rule that is statutorily required by PPACA," the CRS concluded.
So Romney's campaign slogan is calling for an action that simply would not be legal. Waivers are not a solution and, in fact, might well detract from the ultimate goal of repealing Obamacare and replacing it with a genuine free market alternative.
• Mimicking Obama. When Romney says he wants to give states more discretion in implementing Obamacare, there is very little daylight between his position and President Obama's.
The president has said Congress should pass legislation to accelerate the provision in the law that would allow states more flexibility in implementing the health law starting in 2017, arguing Congress should move the date forward to 2014. That is precisely Romney's position. Not much room for debate there.
• Individual mandate affects everyone. Romney seems especially proud of the individual mandate requiring all residents to have health insurance as "the ultimate conservative idea."
When asked about the despised issue, Romney says: "Our bill dealt with eight percent of our population, the people who aren't insured and said to them, if you can pay, don't count on the government, take personal responsibility."
But the mandate applies to everyone, not just to the eight percent who were uninsured.
• Romneycare and taxes. He also defends Romneycare by saying that Massachusetts didn't raise taxes to finance his plan. That's because Massachusetts simply passed a big share of its costs along to federal taxpayers. Massachusetts relied on previously enacted health insurance taxes and an infusion of federal Medicaid money to finance its coverage expansion.
Washington didn't have any higher government authority to draw from so it had to raise taxes to finance Obamacare. The fact that a significant part of Massachusetts' coverage expansion relied on federal Medicaid money defies Romney's position that the Bay State's reform was a state solution.
• Medicare cuts. Romney also boasts, accurately, "We didn't cut Medicare." This is a bogus boast, however, since states have no authority over spending in the federal Medicare program, and cutting Medicare therefore never was an option with Romneycare.
• The speed of repeal. Romney pledges to pursue the ultimate goal of repealing Obamacare and replacing it with "free-market reforms that promote competition and lower health-care costs. But since an outright repeal would take time, an executive order is the first step in returning power to the states," he wrote earlier this year.
Actually, it wouldn't. Romney's cautious step-by-step approach overlooks the fact that the Republican House passed a repeal bill within a few weeks of taking power. If there were a majority in the Senate supporting repeal, then a new president could have a repeal bill to sign on his desk within a month or two of taking office.
Why on earth would a President Mitt Romney want to send states on a wild chase to start implementing Obamacare in a different way when, as he himself observes, the ultimate goal must be total repeal?
ROMNEY'S ATTEMPT TO DISTANCE himself from the despised health care law isn't working. He is simply not able to talk his way around it. A video has surfaced recently of a 2010 appearance by Romney that is causing new alarms in which he says of Obamacare, he would "repeal the bad and keep the good."
There is a way out, however: Romney needs to take a bolder step and say that the law he passed in Massachusetts never would work for our diverse and complex country, that he shouldn't have tried to do so much all at once, and that he should have put health costs, not universal coverage, at the top of his priority list. He needs to emphasize as strongly as he can that a federal mandate to purchase health insurance is unconstitutional and that he wants to sign a bill fully repealing Obamacare. And he needs to explain what really happened in the passage of Romneycare.
The health reform plan he pushed in Massachusetts was different in key respects from the one that became law -- and which became the model for Obamacare.
Few voters know that Romney wanted an escape from the individual mandate, by allowing people to instead be able to post a bond in case they were uninsured and had big medical bills.
When Romney signed the law, he believed it contained the bond escape hatch, but legislators took it out at the last minute.
Romney also objected to the employer mandate and vetoed the provision that requires employers with 11 or more workers to provide health coverage or pay an annual fee of $295 per worker.
He also vetoed several other provisions, and every one of his vetoes was overridden by the overwhelmingly Democratic 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.
If Gov. Romney is serious about repealing Obamacare, he will have to devote all of his energies to doing that as soon as possible.
As primary voters continue their serial search for the non-Romney candidate, Romneycare remains his Achilles' heel. Granting waivers would simply allow Obamacare to sink its roots even deeper into our economy and health sector and would send a mixed message to the Congress, to the states, and to the American people about what he would do.
Unless he takes steps to remedy his position, he will 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.