“Tomorrow Is Another Day”: Mitt Romney’s Ever-Changing Opinion On Health Care
Seeking to soften his image, Mitt Romney has this week taken — again — to touting the health care reform law he enacted as governor of Massachusetts, saying it illustrates his “empathy and care about the people of this country.”
While running for president in 2008, and the following year while the Affordable Care Act was still being crafted, Romney was actively evoking ‘Romneycare’ as a model for federal health reform. All that changed after President Obama signed the law in March 2010, at which point repeal became the Republican Party’s raison d’être. Romney quickly latched on to the cause.
That’s when the relationship between the now-Republican nominee and his signature achievement as governor grew complicated. Here’s a timeline.
April 12, 2006: Birth of Romneycare
Massachusetts Gov. Mitt Romney signs health care reform into law.
February 2, 2007: ‘Model for the nation’
Preparing to run for president, Romney touts Romneycare in a Baltimore speech. “I’m proud of what we’ve done,” he says. “If Massachusetts succeeds in implementing it, then that will be a model for the nation.” He repeats this message in multiple media appearances throughout his presidential run.
January 5, 2008: ‘I like mandates’
In a Republican primary debate, Romney defends Romneycare and its individual mandate. “I like mandates. The mandates work,” he says. “If somebody — if somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way.” He continues to echo this message.
July 30, 2009: Adopt my plan, Mr. President
The national health care debate is raging. Romney takes to USA Today to call on Obama to embrace the tenets of Romneycare. “Obama could learn a thing or two about health care reform from Massachusetts,” he writes, making the case for an individual mandate: “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.”
The federal law enacted in March 2010 includes the three core planks of Romneycare: guaranteed insurance coverage, an individual mandate and subsidies to help people afford to buy their own policies on a regulated exchange.
March 30, 2010: ‘Different as night and day’
Reading the tea leaves, Romney proceeds to channel his party’s calls to unwind Obamacare and insists that it’s different from his plan.
“People often compare his plan to the Massachusetts plan,” he tells the Boston Globe. “They’re as different as night and day. There are some words that sound the same, but our plan is based on states solving our issues; his is based on a one-size-fits-all plan.”
After initially calling for partial repeal, Romney champions the GOP’s push to fully repeal the Affordable Care Act, describing it as both unconstitutional and damaging to the nation.
May 12, 2011: No apology
Weeks before announcing his presidential bid, and under pressure from conservatives to disavow his greatest political accomplishment, Romney gives a speech defending his law but vowing never to impose it on the nation. “Our plan was a state solution to a state problem and his plan was a federal power grab,” he says.
“I also recognize a lot of pundits are saying I should stand up and say this whole thing was a mistake,” he says at the University of Michigan. “But there’s only one problem with that: It wouldn’t be honest. I, in fact, did what I felt was right for the people of my state.”
June 12, 2011: Obamneycare
One day after his Republican primary opponent Tim Pawlenty derisively conflated the two laws with the moniker “Obamneycare,” Romney defends his version in a debate.
“If I’m elected president I will repeal Obamacare,” he says. “And also, on my first day in office … I will grant a waiver to all 50 states from Obamacare.”
Romney proceeds to avoid mentioning Romneycare for the rest of the primaries, but holds the line on the federal-state distinction each time he’s asked about it.
September 15, 2011: ‘One of my best assets’ against Obama
During a Republican primary debate in South Carolina, Romney explains how he will respond to Obama’s contention that he isn’t a credible critic of the Affordable Care Act.
“That will be one of my best assets if I’m able to debate President Obama,” he says, “as I hope to be able to do by saying, ‘Mr. President, you give me credit for what you’ve tried to copy in some ways. Our bill dealt with 8 percent of our population, the people who aren’t insured and said to them, if you can pay, don’t count on the government, take personal responsibility. We didn’t raise taxes, Mr. President. You raise taxes $500 billion. We didn’t cut Medicare.’”
December 7, 2011: ‘It’s not even perfect for Massachusetts!’
Looking to shore up his primary position, Romney puts more distance between himself and his Massachusetts law than ever before. In an interview with the Washington Examiner’s Byron York, he says he actually had serious concerns about his own bill. As for how many other states should mimic his signature law, he replies: “In its entirety, not very many.”
“It’s not even perfect for Massachusetts,” he says. “At the time we created it, I vetoed several measures and said these, I think, are mistakes, and you in Massachusetts will find you have to correct them over time. But that’s the nature of a piece of legislation of this nature. You’ll see what works, what doesn’t, and you’ll make the changes. But they have not made those changes, and in some cases they made things worse. So I wouldn’t encourage any state to adopt it in total.”
June 28, 2012: Upheld
The Supreme Court upholds the Affordable Care Act, and by now Romney has locked up the presidential nomination. “Our mission is clear,” he says. “If we want to get rid of Obamacare, we’re going to have to replace President Obama.” He does not mention Romneycare.
August 8, 2012: Romneycare revival
Accused in a vicious pro-Obama group’s ad of being responsible for the death of a woman by making decisions at Bain that cost her her health care, the Romney campaign seeks to soften his image by saying the Massachusetts law would have covered her.
“Obviously it is unfortunate when anyone loses their job,” says Romney spokeswoman Andrea Saul on Fox News. “To that point, you know, if people had been in Massachusetts under Gov. Romney’s health care plan they would’ve had health care.”
Conservatives threw a fit, unleashing a torrent of criticism at their nominee’s campaign, with some fearing that Saul’s remarks would cost him the election. The criticism, it turns out, would not silence the campaign’s embrace of the law.
August 26, 2012: ‘Very proud’
Fending off Democratic claims that Republicans are waging a “war on women,” Romney says he’s “very proud” that his Massachusetts law gave health care to many women.
“I’m the guy who was able to get all the health care for all the women and men for my state,” he says on Fox News. “They were talking about it at the federal level. We actually did something and we did it without cutting Medicare and without raising taxes.”
September 8, 2012: I like parts of Obamacare — but not exactly
In an interview on NBC, Romney briefly signals support for two key provisions in Obamacare — guaranteed coverage for preexisting conditions and letting young people remain on a parent’s policy until 26, which were also included in Romneycare.
“I’m not getting rid of all of health care reform,” he says. “Of course there are a number of things that I like in health care reform that I’m going to put in place.”
Soon, his campaign clarifies that he wasn’t expressing solidarity with the Affordable Care Act, but was reiterating support for different versions of the ideas. In the case of preexisting conditions, he wants laws protecting those who have maintained continuous coverage, but not first-time buyers. And he says insurers will adopt the under-26 provision on their own.
September 26, 2012: ‘Empathy and care’
Under fire again from the Obama campaign for his taped remarks deriding 47 percent of Americans as freeloaders, Romney cites Romneycare in a national TV interview as evidence of his compassion for ordinary people.
“Don’t forget — I got everybody in my state insured,” he says on NBC. “One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”
On the same day, Romney touts Romneycare in a guest article for the New England Journal of Medicine contrasting his vision for health care reform with Obama’s. “Each state will have the flexibility to craft programs that most effectively address its challenges — as I did in Massachusetts,” he writes, “where we got 98 percent of our residents insured without raising taxes.”
By: Sahil Kapur, Talking Points Memo, September 29, 2012
“A Fateful Misposition”: Romney Didn’t Change Fast Or Far Enough
If you want to understand the recent, present, and probably future direction of the conservative movement and its wholly owned subsidiary, the Republican Party, it’s important to understand how thoroughly and rapidly it has engineered a revolution in the GOP, now that dissent from The Truth is ill-tolerated. A useful way to get a grip on this phenomenon is, of course, to look at Mitt Romney’s efforts to accommodate himself to the ever-changing zeitgeist. Sometimes you get the impression that Romney was this solid moderate Republican the day before yesterday, and only became “severely conservative” in this cycle. But as Steve Kornacki reminds us today at Salon, Mitt started repositioning himself to the right a long time ago–just not fast and far enough:
Romney began making moves toward a White House run nearly a decade ago, shifting away from his moderate Massachusetts roots and positioning himself to meet the national GOP’s various ideological tests. The Massachusetts healthcare law was to play a key role in this self-reinvention. It would give Romney a major bipartisan gubernatorial achievement, burnish his credentials as a forward-looking leader (and not just a simple panderer), and give him a huge general election asset – a universal coverage law that he could use to deflate the inevitable Democratic attacks about his lack of compassion and to stir hope among voters that he knew how to accomplish Big Things.
So Romneycare was not a legacy of RINO moderate heresy (you have to look back at the things he said during his 1994 Senate race against Ted Kennedy to find a lot of items that send conservatives completely over the wall), but a token of then-prevailing conservative orthodoxy. For two interlocking reasons–the decision by conservatives that any efforts to achieve universal health coverage were inherently “socialistic,” and the strategic decision to oppose everything proposed by Barack Obama as a step down the road to totalitarianism–Romney’s positioning turned out to be wrong. It’s worth remembering that his most serious “true conservative” rivals for the nomination, Rick Perry, Newt Gingrich and Rick Santorum, made similar mistakes.
In Romney’s case, however, this mispositioning has been especially fateful because it knocked the props from beneath his slender record of accomplishment, as Kornacki notes:
When Obama embraced RomneyCare and the GOP embraced reflexive opposition, it left Rommney with nothing to say.
And that’s where he is today, alternating between a failing “economic referendum on Obama” message and serial broken promises to lay out a positive agenda that isn’t the Ryan Budget with a side dish of Christian Right cultural extremism. If there was a Bain Capital for politicians, it would probably tell Mitt he needs to blow it all up and start over.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, September 27, 2012
“The Other Mitt”: No Health Insurance? Romney Says “Freeloading” In The ER Is Now All Good
Whether you support the candidacy of Mitt Romney or not, we all should be able to agree that his experience as Governor of Massachusetts—at the time when the first universal healthcare law in the nation was conceived and placed into operation—makes him something of an expert on the subject of health care economics.
And that is precisely what makes his comments during last night’s edition of “60 Minutes” all the more bizarre.
When asked whether the nation has a responsibility to provide health care to the 50 million Americans who do not currently have coverage, the Governor responded;
“Well, we do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”
Never mind that ‘60 Minutes’ interviewer Scott Pelly was quick to accurately point out that ER care is the most expensive form of treatment that one can access. What is far more interesting is that the remark so clearly puts Governor Romney at odds with the other candidate seeking the presidency—and I don’t mean Barack Obama.
I refer, of course, to the ‘other’ Mitt who seems to come and go at various moments in the campaign, offering up direct contradictions to the positions of the Mitt Romney we watched last night on the CBS news show.
You see, it was the ‘other’ Mitt who said during a 2010 interview over at MSNBC—
“It doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility.”
And it was the ’other’ Mitt who told Glenn Beck in a 2007 interview—
“When they show up at the hospital, they get care. They get free care paid for by you and me. If that’s not a form of socialism, I don’t know what is. ”
Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.
It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.
As noted by the current incarnation of the GOP candidate, when a patient turns up at the ER with severe stomach pain, that patient will be treated until her condition is stabilized. But it is the ‘other’ Mitt Romney who understands that, when the tests administered in the ER reveal that the patient has Stage One stomach cancer, it will not be up to the ER to administer the six months of chemotherapy that will be required to save the patient’s life. For that, the patient better be insured or face a truly precarious situation.
The ‘other’ Romney understands that ER care is insufficient to truly treat many patients and that, even when it was possible to get the desired result via ER care, it is the worst possible way to administer health care.
Here’s a thought—maybe current candidate Romney should consider getting rid of his failing campaign staff and see if he can entice the ‘other’ Mitt Romney to join the campaign as a strategist and adviser.
At the end of the day, I think we’d all be better off for it.
By: Rick Ungar, Contributor, Forbes, September 24, 2012
“A Ridiculous Argument”: The GOP’s Emergency-Room Argument Never Dies
CBS’s “60 Minutes” ran fairly long interviews last night with both President Obama and Mitt Romney, and the latter made some news with answers on tax policy. While they’re likely to have a political impact, substantively, the Republican’s answers on health care were even more striking.
Following up on Friday’s release of 2011 tax returns, Scott Pelley asked whether it’s fair that Romney pays a lower federal income tax rate than “the guy who makes $50,000.” The Republican conceded it’s a “low rate,” but nevertheless said it’s fair — the reduced rate is the “right way to encourage economic growth — to get people to invest, to start businesses, to put people to work.”
This is no small admission. The multi-millionaire candidate pays a lower tax rate than most of the middle class — and the rate would have been even lower had Romney not artificially inflated it purely for political reasons — and if elected, he’ll fight to keep it that way.
But this exchange on health care struck me as every bit as interesting.
Pelley: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?
Romney: Well, we do provide care for people who don’t have insurance, people — we — if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.
Pelley: That’s the most expensive way to do it.
Romney: Well the–
Pelley: In an emergency room.
When it comes to health care policy, this might be one of the more important moments of the presidential race. Romney doesn’t believe the United States has a responsibility to provide health care coverage to its own citizens — the Republican Party is the only major political party in any democracy on the planet to hold this position — but he does see emergency rooms as an avenue for caring for the uninsured.
And as a policy matter, that’s deeply absurd.
Long time readers may recall this is a long-time focus of mine, but so long as it keeps coming up, it’s worth setting the record straight from time to time.
It’s true that under the preferred Republican system — American health care before the Affordable Care Act passed — if you’re uninsured and get sick, there are public hospitals that will treat you. As Romney noted on camera, if you have a heart attack, you can call 911 and medical professionals will come get you and give you care.
But it’s extremely expensive to treat patients this way, and it would be far cheaper, and more medically effective, to pay for preventative care so that people don’t have to wait for a medical emergency to seek treatment.
For that matter, when sick people with no insurance go to the E.R. for care, they often can’t pay their bills. Since hospitals can’t treat sick patients for free, the bills can still bankrupt those who get sick, and the costs are still passed on to everyone else.
In other words, it’s the most inefficient system of socialized medicine ever devised.
And in the bigger picture, it’s worse than that. For those with chronic ailments, this position is a pathetic joke — is anyone going to stop by the emergency room for chemotherapy or diabetes treatments?
Romney’s argument isn’t a responsible approach to American health care in the 21st century; Romney’s argument is ridiculous.
By: Steve Benen, The Maddow Blog, September 24, 2012
“The Grandfather Of Obamacare”: How Mitt Romney Paid For Romneycare With Federal Help
Republican presidential candidate Mitt Romney told Univison in an interview Wednesday that he did not mind when President Obama called him the “grandfather” of Obamacare when referring to the program Romney instituted when he was governor of Massachusetts. Quite the opposite. Romney thought other states might take a page from the Massachusetts playbook.
We didn’t have to cut Medicare by $716 billion. We didn’t raise taxes on health companies by $500 billion, as the president did. We crafted a program that worked for our state. I believe the right course for health care reform is to say for each state we’re going to give you the Medicaid dollars you’ve had in the past, plus grow them by 1 percent. And you, as the states, are now going to be given targets to move people to insurance, and you craft programs that are right for your state. Some will copy what we did; others will find better ideas.
Romney is right: The state of Massachusetts did not cut Medicare to finance health care (nor could it have, as states don’t have a say in the federally financed entitlement budget). Whereas the Affordable Care Act levies a tax on insurance companies and makers of medical devices, the Massachusetts law has no similar provision.
But could a state with a capped Medicaid budget, as Romney has proposed, copy what Romney did in Massachusetts and end up with universal coverage? Romney’s own experience suggests probably not: His state a special pot of federal money, alongside a preexisting assessment on hospitals and insurers, to expand insurance coverage to 98 percent of its population.
Way back in 1985, under then-Gov. Michael Dukakis, Massachusetts set up a program called the Uncompensated Care Pool. Much like the name suggests, the pool is used to finance health care for those without insurance. Massachusetts financed the plan largely through assessments on hospitals and insurers. Under Romney’s administration In 2004, each industry paid in about $157 million to keep the pool running. That plan still operates today — under the name Health Safety Net – and covers health care needs that Massachusetts residents cannot afford.
Since the late 1990s, Massachusetts has also received additional Medicaid funds to enroll populations that other states traditionally do not cover. In 2005, when Romney was governor, the federal aid amounted to $550 million. As former Romney adviser John McDonough explains in his book “Inside Health Policy,” the funds were crucial to laying the foundation for universal health coverage. He takes us back to 2005, when the George W. Bush administration was getting ready to end that special funding arrangement:
“In Masachusetts, $350 million is a lot of money, and the news set off alarm bells. Governor Romney reached out and formed a partnership with Senator Kennedy to scheme how to keep the extra federal dollars coming. At that moment, the state’s mundane desire to retain federal dollars merged with the policy goal of universal coverage to create a new policy imperative. Romney and Kennedy proposed that Massachusetts keep receiving the extra payments and in return the state would shift the use of those dollars [to] subsidies to help lower-income individuals purchase health insurance coverage.”
Ryan Lizza recounts a similar version of events in his New Yorker article on Romneycare. That state ultimately secured three years of additional Medicaid funding, $1.05 billion, which largely financed the Massachusetts expansion. Both accounts suggest that it was a special commitment from the federal government, rather than a capped budget, that spurred Massachusetts’ success.
Since then, employers and individuals have chipped in to keep the universal coverage program afloat. The Blue Cross Blue Shield Foundation of Massachusetts saw spending by both of those groups increase in the year after Romneycare became law, which they attribute to rising medical costs and the insurance expansion.
Five years later, it’s largely federal funding that keeps Massachusetts’ universal coverage afloat. Since 2005, the state has twice renewed that federal waiver — the one Lizza and McDonough wrote about — to provide additional Medicaid dollars to the state.
The most recent renewal was last December 2011, when the state secured $26.75 billion in federal funds over the course of three years. It will, among other programs, continue to finance the universal coverage program.
“The milestone agreement also ensures the ongoing success of Massachusetts’ historic health care reform initiative, through which more than 98 percent of the Commonwealth’s residents, and 99.8 percent of children, have health insurance,” Massachusetts Health and Human Services Secretary JudyAnn Bixby wrote at the time. “The waiver fully funds our ongoing health care reform implementation.”
So Massachusetts used not just federal Medicaid money but federal dollars above and beyond that Medicaid money to finance their health reforms. It is difficult to see how Romney’s proposal to cut Medicaid spending and hand that reduced share over to the states would allow other states to follow Massachusetts’ example. It might not even permit Massachusetts to continue following Massachusetts’ example.
By: Sarah Kliff, The Washington Post, September 21, 2012
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