[NOTE: I wrote the gist of this piece last night and was just polishing it up for publication when I noticed that Obama is giving a speech in Boston that apparently advances the “Obamacare was a Republican idea” argument I discuss here. If so (I haven’t read it or heard it yet), how diabolically clever and—if I may use a favorite word of his—audacious of him. I wonder whether that will be the prelude to a future claim that we need a real Democratic solution rather than a half-baked Republican one: single payer.]
Remember the big Romneycare battle during the 2012 primaries and election? That Obamacare was just Romneycare writ large?
As Obamacare runs into troubles, expect more of that as an argument from the left, “We were just enacting a Republican idea, so don’t blame us, blame them“—even though “they” didn’t vote for it.
I wrote a lot about Romneycare during 2011 and 2012 and how it differed from Obamacare and also from what Romney had wanted enacted in Massachusetts and from what Republicans in general had proposed (including, of course, the state-vs-federal government question). The Boston Globe, which had covered Romneycare in some depth, wrote:
Romney…hated the employer mandate and vetoed the provision that employers of 11 or more offer coverage or face a penalty of $295 per employee. This veto, and seven others aimed at less controversial aspects of the law, were easily overridden by the Democratic Legislature.
Romney considers the Massachusetts plan needlessly gold-plated; he would have pushed for a much cheaper version that allowed minimal coverage options.
He believes the Massachusetts health connector, the insurance exchange which the Obama plan would emulate, has created an excessive regulatory burden, imposing too many requirements on what commercial insurers must offer for a policy to qualify as “minimum creditable coverage’’ under the law. His proposal, to require only a bare-bones policy that covered hospitalization and catastrophic illness, was rejected by the Legislature…
Romney also wanted a way for those of means to opt out of the mandate by posting a bond — essentially a promise to pay for future uninsured health care costs. Critics called it a “fig leaf’’ and Romney concedes that few would have taken advantage — just as only a handful choose a similar option to post a $10,000 bond rather than buy compulsory auto insurance in Massachusetts.
But the principle mattered to him, and the failure of the Legislature to agree still rankles…
And as for those on the economic margin, Romney thought that no one, however poor, should get insurance for no cost at all. He advocated a small premium, even a few dollars a month, for the neediest, but the Legislature balked.
It’s interesting to note how different Obamacare (and even Romneycare) would have been if they had actually followed Romney’s recommendations. But twas not to be. And now the issue gains renewed importance.
This article by Avik Roy is the clearest and most cogent explanation of another major difference between the two:
In 1996, the heavily Democratic state legislature passed the Non-Group Health Insurance Reform Act, which transformed the individual market for health insurance, the market for people who shop for private insurance on their own.
The contours of that bill will sound familiar to observers of the Obamacare debate; it forced insurers in the individual market to cover everyone, regardless of pre-existing conditions, and it forced insurers to charge nearly equal rates to the young and the old, despite the fact that younger people consume very little health care. Governor Weld signed it into law.
The predictable happened. Because people could stay uninsured until they were sick, and then sign up for insurance afterwards, premiums shot up for the chumps who stayed continuously insured through health and illness. Over time, fewer and fewer people could afford insurance on the individual market; eHealthInsurance.com dropped out of the state entirely.
Romneycare, for all its flaws, was a way to bring Massachusetts’ individual insurance market back from the brink. It didn’t repeal the destructive but popular provisions from 1996; instead, it required everyone to buy health insurance — the infamous individual mandate — in order to make the market function again. It also merged the individual-insurance market into the one for small employers, in order to stabilize the former.
With a legislature that was 85% Democrat, there was nothing Romney could do to go backwards and do away with the requirement for equal rates and mandated coverage for pre-existing conditions. But he did what he could to move the Massachusetts healthcare insurance system to the right of where it had been before, and he wanted to move it even further right by vetoing certain of its provisions, vetoes which the Massachusetts legislature promptly overruled.
Details matter—a lot. But how many people pay attention to them? Obama is counting on the fact that they don’t, and won’t.
[NOTE: Here’s another big difference: “The majority of the citizens of Massachusetts wanted ‘Romneycare.’ The majority of American citizens did NOT want ‘Obamacare.’”]
[ADDENDUM: If you want some comic relief—and I bet we could all use some—go to the comments at this thread and scroll down to the ones that take the form “Mitt Romney told me to…”]
[ADDENDUM II: Romney replied in advance of Obama’s speech.]