Romney’s position got trickier in 2009, as President Obama and the Democrats advanced their own health-care bill and Republican opposition to it grew. For much of the year Romney emphasized that the Democratic plan contained something the Massachusetts law didn’t: a “public option” whereby the federal government would directly provide health insurance to anyone who wanted it. But congressional negotiations killed the public option, and the plan was left looking very similar to Romney’s. Conservative voters for the first time began to think about a government mandate to buy health insurance — and instantly disliked it.
Since Obamacare passed without a public option, Romney has distinguished between his plan and Obama’s on two grounds. He repeated his case in a mid-May speech on health care. First, Romney differentiated his plan by pointing to Obamacare’s funding mechanisms. Obama cut Medicare, at least on paper, to fund his plan. As a governor Romney couldn’t do that, and he now says he opposes “diverting” Medicare funds that way. Obama raises various taxes, too, which Romney opposes. (It was Romney’s successor who raised taxes to pay for the health law.) Second, his plan is a state plan rather than a national one: an expression of American federalism rather than an assault on it. “A state solution to a state problem” is how he put it in his speech. He continues to support federal legislation that most conservatives would like; indeed, his latest proposals are slightly more conservative than the ones he advanced in 2008.
Politically, these defenses are only slightly better than nothing. The first one sidesteps the part of the Massachusetts plan that most bothers conservatives: the individual mandate it shares with Obamacare. The second argument will appeal to some conservatives. A state mandate does not raise the constitutional concerns the federal one does. But conservatives who consider the federal mandate incompatible with individual liberty will not find it much more congenial at the state level. The mandate, by the way, is also the most unpopular part of the law with the public at large. That is not an issue Romney would be able to bring up against Obama as the party’s nominee.
Even after his latest speech, the health-care issue remains extremely dangerous to Romney for several reasons. It exacerbates the character issue. He cannot repudiate the plan because he already flip-flopped on so many issues during the 2008 race, including abortion, guns, immigration, and gay rights. But defending the plan makes him look slippery, since the only way he can do it while running for the Republican nomination is to pretend that it is nothing like Obama’s law.
The unpopularity of the law among Republican primary voters also means that Romney cannot brag about his main legislative accomplishment as governor. Take it out of the picture — which is the best-case scenario for Romney — and primary voters are left looking at a rich, smooth former governor of Massachusetts who cannot point to any big success in office.
The early results of the Massachusetts law are not especially helpful to Romney, either. Yes, the proportion of Massachusetts residents without insurance — already small before the law — has gone down a little bit. But wait times to see a doctor remain long and premiums are still rising faster than the national average. Emergency-room visits haven’t dropped as promised. The exchanges, instead of promoting free markets, are on the verge of connecting price controls to insurance policies. The law’s popularity in the state is falling. More bad news for Romney: Conservatives making the case against Obamacare are using the Massachusetts example as a warning of what is to come.
Romney’s explanations are, in aggregate, more inadequate than they are individually, because their multiplicity suggests he has a big mistake to defend. And then there is this exchange, from a few weeks after Obamacare passed. The president cited Romney’s law in defending his own. Romney, in response, noted that Obama had previously accused Republicans of having no ideas. He said that the president could not have it both ways. He added, “If ever again somewhere down the road I would be debating him, I would be happy to take credit for his accomplishment.” Taking credit for Obamacare. If any other candidate had said it, one would have assumed that he was drunk.