WASHINGTON – It’s almost too perfect.
Of all the GOP candidates President Barack Obama could possibly face in the 2012 election, he’s been matched against Mitt Romney.
As presidential opponents tend to be, Romney and Obama are on opposite sides of nearly every policy issue – not least, if only ostensibly, healthcare.
Except for one uncomfortable fact. Obamacare – the “Crown Jewel of Socialism” (in Michele Bachmann’s famous turn of phrase), which has been decried by many on the right as nothing short of socioeconomic Armageddon – is based almost exactly on the healthcare law Romney spearheaded as governor of Massachusetts in 2006.
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It’s an ironic and vexing state of affairs. A fact that Romney has tried to deflect, deny and otherwise shy away from thus far on the campaign trail.
For that precise reason, of course, it’s a fact Obama has been all too happy to highlight – never missing a chance to tweak Romney with reminders of his former self. In April, for instance, on the sixth anniversary of the Bay State’s healthcare reform law, the Obama camp released an ad spotlighting the many things the two laws have in common.
So how similar are Obamacare and Romneycare?
Short answer: Very.
Same, only slightly different
The two laws share the same philosophy of near-universal coverage and the same basic “three-legged stool” structure: 1) disallowing discrimination by payers; 2) mandating that people purchase coverage; and 3) subsidizing that coverage for those who can’t afford it.
And not only that. Both laws were designed and drawn up by some of the same economists and health policy experts, such as Jonathan Gruber, a professor of economics at MIT (pictured at top left).
“Basically, they’re the same [bleeping] bill,” Gruber told the New York Daily News.
In an interview with Healthcare IT News, Gruber used no such salty language, alas, but his message was the same.
“Obamacare is based on Romneycare,” he says. “Myself and a number of Massachusetts experts were brought down to Washington to help them develop it, based on what we’d done in Massachusetts.”
One big difference?
“Obamacare is more ambitious in one important way: Romneycare did not try at all to tackle healthcare cost control, whereas Obamacare does,” Gruber says. “So you can think of it as a more ambitious version of Romneycare.”
Sure, there are many other variations, as one would expect, between a law crafted for a commonwealth of 6.5 million people and another designed for a nation of 312 million.
And they aren’t always different in the ways one might expect. When it comes to the much-maligned “individual mandate,” for instance, while Romneycare penalizes Massachusetts residents who don’t buy insurance a not insubstantial $1200, the penalty under the Affordable Care Act is $695, or 2.5 percent of income.
Both laws require citizens to buy insurance, and both require employers to provide it. In Massachusetts the penalty for businesses with 11 employees or more who don’t make a “fair and reasonable contribution” to their health coverage is about $300 per worker. With Obamacare, the businesses required to comply get bigger (only those with 50 or more people on their payroll), but so do the fines: $2,000 penalty per employee.
“In the Massachusetts law we have a very small penalty for employers who don’t offer health insurance,” Gruber explained. “With the federal law, it’s much larger. I would say that’s a very big difference.”
Other small differences are more or less cosmetic. While both plans allow kids to stay on their parents’ insurance until age 26, for example, Romney’s law specifies that they maintain coverage for two years after they stop being claimed as dependents or until they turn 26, whichever happens first.
But one more big place the laws are at odds has to do with the subsidies it offers to help people purchase insurance. The Bay State subsidizes folks who earn up to 300 percent of the poverty level; the ACA helps out anyone under 400 percent of the poverty level – but gives them less of a subsidy.
“In Massachusetts, our subsidies to low-income families are much more generous than those in the federal law,” Gruber adds. “The federal law makes low-income families pay a lot more of their healthcare costs than does the Massachusetts plan.”
So yes, there are differences – but in Gruber’s words, “the basic structure’s the same.”
Which is why it’s so galling – if entirely unsurprising – to see Romney (pictured at right) either avoiding or disavowing his signature achievement as governor when he’s on the hustings.
Disingenuous Romney
When Romney does deign to speak about the Massachusetts law, he is mealy-mouthed, essentially saying healthcare laws should be up to the states, or that what was good for Massachusetts is not necessarily good for the rest of the country.
“That’s disingenuous,” says Gruber, a Democrat. “First of all, there’s no reason why it wouldn’t be right for other states. He never says why.”
Second, Gruber says, the only way Massachusetts could enact its law in the first place was with the help of federal contributions. “So if Romney’s willing to say, ‘I’ll pony up the money for other states that want to do this,’ that’s one thing. But he’s not saying that,” Gruber adds. “You can’t do it without the same help from the federal government that we got. So he’s being very disingenuous in that position.”
Beyond fiscal issues, however, Romney is also being ideologically insincere.
When Romney left office in 2007, he and his aides took with them hard drives from 17 state-owned computers, having also scrubbed emails from his office PC.
But earlier this month, the Wall Street Journal uncovered a trove of correspondence that showed just how strongly he believed in his health reform law – especially the individual mandate.
Indeed, his aides even toyed with some ideas that were too extreme for Democrats, such as naming and shaming employers that didn’t offer coverage.
“I know the dems hate this, but we can also [throw] back in the Gov’s original notion of having some sort of ‘public disclosure’ of employers who promote a culture of uninsurance,” wrote Romney advisor Cindy Gillespie on Feb. 13, 2006.
Romney made no secret of his affection for the individual mandate. He had no reason to, since it’s essentially a conservative idea. As he wrote in a July 2009 USA Today op-ed, recently dug up by BuzzFeed:
Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar. Second, we helped pay for our new program by ending an old one — something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.
“He was a firm believer in the individual mandate,” Gruber says. “He believed in it very strongly on moral grounds, and basically felt there were people in Massachusetts who could afford health insurance and weren’t buying it, therefore free-riding on the rest of us.
“My contribution to the debate was to bring the numbers to bear and say, not only is that a moral argument, there’s actually a financial argument that it’s a cost-efficient way to cover the uninsured,” Gruber adds. “Those arguments together got him very excited about the mandate and he was a huge proponent.”
Republicans falling for pieces of Obamacare
Simply put: Obamacare is a conservative plan with the very intention of reforming the payment system to save the federal government – and its taxpayers – billions if not trillions of dollars, and simultaneously bolster patient care.
“The credit here should go to Barack Obama for adopting a fundamentally Republican plan [rather than] universal coverage. So thumbs up to him, and thumbs down to Romney and the Republican Party for essentially running away from their idea,” Gruber says. “I mean, at the [Massachusetts] bill signing, on the podium was a guy from the Heritage Foundation, a conservative think tank, praising the conservative principles behind this bill. I mean, that was six years ago! This wasn’t a hundred years ago, it was six years ago. It’s pure, craven politics that they’re now running away from this.”
Source: Healthcare Finance News