The Corner

Re: What Really Happened with Romneycare

Grace-Marie, another aspect of Romneycare strengthens both your point, and Avik’s, namely the history of health-reform efforts in Massachusetts. It’s crucial to recall that Massachusetts was one of eight states that adopted sweeping health reforms during the 1990s after the Clinton health-reform effort failed.  These reforms were all based on the disastrous scheme of “guaranteed issue” — the essence of Obamacare — and without exception all those reforms produced varying degrees of disastrous results. In most cases private insurers were largely driven out of the individual-insurance market (i.e., the market outside federally regulated group plans), and in several states, the reforms were fully repealed within just a few years. (I went into all of this in more detail in my Supreme Court amicus brief on severability in the Obamacare case)

Long story short, it was during Governor Romney’s administration that the Massachusetts legislature finally faced the dire need to fix the mess created by its comprehensive health reform efforts of a decade before. Liberal members concluded (as usual) that the reason the reform efforts failed was not too much government intervention, but not enough. Led by Governor Romney, conservatives fought to keep the legislation economically rational, pushing market alternatives to the worst liberal proposals. The result quite different from Governor Romney’s vision of health reform, but it was also much better than it would have been if he hadn’t fought to keep Massachusetts liberals from going crazy and making a bad situation much worse. 

One key takeaway from this history is that “Romneycare” — to the extent that the current system in Massachusetts can be attributed to Governor Romney — cannot accurately be said to include guaranteed issue and other reforms that produced the disaster there to begin with. Governor Romney was not responsible for a comprehensive health-care scheme that is in any way comparable to Obamacare. He was trying to fix the problems created by a scheme that was comparable to Obamacare, namely the ill-advised 1996 reforms.

People should stop fixating in the individual insurance mandate, which is not nearly the worst aspect of Obamacare. The worst aspect is its Medicaid expansion and open-ended premium-support subsidies for everyone making up to 400 percent of the federal poverty level. That massive new middle-class entitlement, combined with the other guaranteed-issue policies, premium restrictions, and coverage requirements in the core health-insurance reforms of Obamacare, is almost certain to prove disastrous both for our fiscal picture and for the health industry. Those subsidies are Obamacare’s major step in the direction of socialized medicine. Governor Romney properly opposed a similar scheme at state level and has opposed it nationally.  

Mario Loyola — Mr. Loyola, a former foreign-policy adviser at the Pentagon and in the U.S. Senate, is a visiting fellow at the National Security Institute at George Mason University’s Antonin Scalia Law School.

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