The Obama campaign is out with a new video celebrating the “Anniversary of Romneycare.” It shows clips of MIT economist Jonathan Gruber and Massachusetts universal-coverage activist John McDonough describing their involvement in both Romneycare and Obamacare.
But, as Jennifer Heldt Powell and Joshua Archambault discuss in a new book from the Pioneer Institute called The Great Experiment, there’s a key step missing in the comparisons between Romneycare and Obamacare: how Romney’s successor in Massachusetts, Deval Patrick, implemented the law by gutting its market-oriented aspects.
Because of time pressures that the state was under to pass a law quickly — or lose $385 million in federal Medicaid funds — key details of the law were left up to those who directly implemented them. “The final bill left significant decision making to [Massachusetts government officials],” writes Powell. “The board was still within its mandate when it took a significantly different direction than was intended by some involved in the original compromise.”
Romney vetoed the employer mandate; Democrats in Boston and Washington imposed one. Romney sought to require individuals to purchase inexpensive catastrophic insurance; Democrats in Boston and Washington forced individuals to buy costly, comprehensive plans. Romney sought a diverse market of insurance plans for small businesses; Democrats in Boston and Washington restricted insurance choices to three generous tiers.
And this is all before you get to the important differences between a state-based health reform plan and a federal one. “Our health care plan was not designed for 50 states,” Romney said in April 2006. “It was designed for one state. We’re going to have an experiment the other 49 states can look at, elements they can adopt.”
A state-based plan is constrained by the fact that it must work within the constraints of federal law and federal programs, like Medicare, Medicaid, and the tax exclusion for employer-sponsored insurance. The reason Democrats liked Massachusetts as a model is because it largely left those big federal programs untouched.
Two of the critical differences between what Romney sought and what Democrats achieved involve the Massachusetts law’s twin mandates on individuals and employers to purchase health insurance. Romney vetoed the employer mandate in Massachusetts; Democrats in the legislature overrode his veto. Obamacare did not follow Romney’s model in this key regard: The Affordable Care Act includes an employer mandate.
Romney sought to require everyone to buy catastrophic insurance in order to cover emergency care; however, the Patrick administration implemented the law so as to force everyone to buy costly, comprehensive insurance. Obamacare, once again, did not follow Romney’s model: The Affordable Care Act requires people to buy comprehensive coverage.
As I write in the piece, Romney erred in supporting an individual mandate. It’s a loaded gun that, in the hands of people with a different philosophy, will be used to force people to buy insurance that they don’t need, and to subsidize others who have been less responsible. Ironically, it is Deval Patrick’s departure from Romney’s approach to the mandate — forcing people to buy comprehensive coverage far in excess of their needs — that may be Obamacare’s undoing in the Supreme Court.
As Yuval Levin and Ramesh Ponnuru put it in the pages of NR, “Silence, or a muted critique of Obamacare, would be a mistake for several reasons. It would undermine the ability of a President Romney to govern successfully on health care. It would leave a key Obama weakness unexploited.”
Yes, Obamacare was modeled after the Massachusetts health law. And Romney has gotten plenty of grief for that. But it’s more precise to say that Obamacare was modeled after the way in which Democrats implemented Romney’s law, especially with regards to the law’s individual and employer mandates. And Romney has consistently opposed a one-size-fits-all federal solution that concentrates power in the secretary of health and human services.
When President Obama and Governor Patrick highlight Romney’s role in their achievements, they invite Romney to make these important distinctions.
— Avik Roy is a senior fellow at the Manhattan Institute and the author of The Apothecary, the Forbes blog on health-care and entitlement reform. He is an adviser to the Romney campaign on health-care issues. You can follow him on Twitter at @aviksaroy.