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.”
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