Mitt Romney on Health Care Former Republican Governor (MA); presidential nominee-apparent

Sub-sections under Health Care:
• ObamaCare
• RomneyCare
• Other issues under Health Care

Shift Medicaid to states, plus inflation, plus 1%

ROMNEY: I would like to take the Medicaid dollars that go to states and say, you're going to get what you got last year, plus inflation, plus 1%, and then you're going to manage your care for your poor in the way you think best. One of the magnificent things about this country is the whole idea that states are the laboratories of democracy. Don't have the federal government tell everybody what kind of training programs they have to have and what kind of Medicaid they have to have. Let states do this.

OBAMA: Governors are creative. But they're not creative enough to make up for 30% of revenue on something like Medicaid. What ends up happening is some people end up not getting help.

ROMNEY: If a state gets in trouble, well, we can step in and see if we can find a way to help them. The right approach is one which relies on the brilliance of our people and states, not the federal government.

Restore $716B in Medicare cuts

ROMNEY: That's $1 for every $15 you've cut. They're smart enough to know that's not a good trade. I want to take that $716 billion you've cut and put it back into Medicare. By the way, we can include a prescription program if we need to improve it. But the idea of cutting $716 billion from Medicare to be able to balance the additional cost of ObamaCare is, in my opinion, a mistake.

No change to near-retirees; Medicare vouchers for young

OBAMA: I don't.

ROMNEY: Again, that's for future people, not for current retirees.

OBAMA: In fairness, what Gov. Romney has now said is he'll maintain traditional Medicare alongside it. But those insurance companies are pretty clever at figuring out who are the younger and healthier seniors. They recruit them, leaving the older, sicker seniors in Medicare. And the traditional Medicare system will collapse.

ROMNEY: What I support is no change for current retirees and near-retirees to Medicare. And the president supports taking $716 billion out of that program.

Q: And what about the vouchers?

ROMNEY: For people coming along that are young, what I do to make sure that we can keep Medicare in place for them is to allow them either to choose the current Medicare program or a private plan. Their choice.

Give young people a choice of Medicare or private insurer

ROMNEY: For people coming along that are young, allow them either to choose the current Medicare program or a private plan. Their choice. They get to choose--and they'll have at least two plans that will be entirely at no cost to them. So they don't have to pay additional money, no additional $6,000. That's not going to happen. And if the government can be as efficient as the private sector and offer premiums that are as low, people will be happy to get traditional Medicare or they'll be able to get a private plan. I know my own view is I'd rather have a private plan. I'd just as soon not have the government telling me what kind of health care I get. I'd rather be able to have an insurance company. If I don't like them, I can get rid of them.

OBAMA: Medicare has lower administrative costs than private insurance; private insurers have to make a profit.

Develop countermeasures for global pandemics

A: Pandemics are not new--they have happened at different points throughout human history. And it is a certainty that, at some point in the future, they will happen again. Fortunately, America today is better prepared than ever to face a pandemic. In part, this is because researchers are learning so much more about infectious diseases, how they work, and how they spread. Unfortunately, globalization has enabled the spread of these diseases much more rapidly. To further improve preparedness, we must continue to invest in the best public health monitoring systems that can be built. I will also encourage advancements in research and manufacturing to increase scientific understanding of new pathogens. The development of new countermeasures, from diagnostics to antivirals, will help protect human lives in the face of new bugs and superbugs.

Preventive vaccines require robust R&D enterprises

A: The first priority must be to ensure that America has adequate supplies of safe and effective vaccines. Making vaccines requires complex facilities and highly skilled workers, which means that America must continue to strengthen its advanced manufacturing capabilities.

Second, preventing outbreaks of these diseases also requires that these vaccines are used effectively. The vaccines only work to prevent outbreaks when a sufficient number of people are protected from the diseases and thus able to stop a bug from spreading from one person to the next.

Finally, America must have a robust research and development enterprise capable of constantly improving on the tools available to prevent these diseases. That means taking steps to ensure that America remains the most attractive place to develop and commercialize innovative, life-saving products like vaccines.

Official portrait had 2 symbols: his wife, & healthcare

Romney hoped the revolution in health care that he, more than anyone, had driven in to law would redound to his benefit as a presidential candidate. Who else on the Republican side had tried to do anything as difficult or ambitious--much less gotten it done?

On choosing providers: "I like being able to fire people"

Romney made the comment while touting a health care approach that would allow people to purchase their own insurance, which Romney said would give the companies an incentive to keep their customers happy and healthy.

"It also means that if you don't like what they do, you can fire them," Romney said. "I like being able to fire people who provide services to me. If someone doesn't give me the good service I need, I want to say, you know, I'm going to go get someone else to provide that service to me."

Romney commented that he feared several times getting a "pink slip," though he and his campaign did not describe when the multimillionaire venture and equity investor ever worried about being dismissed from a job.

2010: Consider single-fee structures, at state level

Instead of abandoning his signature plan for Massachusetts, four of Romney's sixty-four points identify the steps that must be taken to develop an efficient health care system, such as considering "single-fee structures," consumer incentives for adopting healthy lifestyles, renewed emphasis on preventative care, and malpractice tort reform.

When he revised "No Apology" after the midterm elections in 2010, Romney turned up the political rhetoric. Yet he did not back off on the Massachusetts health care plan. Instead, he underscored earlier arguments that it should not be implemented on a national basis, that it ought to be left to the states, and that to do otherwise would be a violation of states' rights.

Reform Medicare, but don't cancel prescription program

PERRY: No. But it's a $17 trillion hole that we have in our budget we've got to deal with.

Q: [to Romney] How about you?

ROMNEY: I wouldn't repeal it. I'd reform Medicare and reform Medicaid and reform Social Security to get them on a sustainable basis, not for current retirees, but for those in their 20s and 30s and early 50s.

Health Savings Accounts give patients stake in health costs

CAIN: First, repeal Obamacare in its entirety. Secondly, [market reforms]: deductibility of health insurance premiums; loser-pay laws; and association health plans.

ROMNEY: Herman Cain is right, and let's get back to getting the cost of health care down. The reason health care is so expensive is not just because of insurance, it's because of the cost of providing care. And one reason for that is the person who receives care in America generally doesn't care how much it costs, because once they've paid their deductible, it's free. And the provider, the more they do, the more they get paid. And so what we have to do is make sure that individuals have a concern and care about how much something costs. And for that to happen, health savings accounts. Give people a stake in what the cost of insurance is going to be, what the cost of it is going to be. Co-insurance, where people pay a share of the bill, that makes a difference.

Cap medical malpractice punitive damages at $500,000

• Closing loopholes in the $500,000 cap on non-economic damages which allowed lawyers to win excessive damages
• Reducing lawsuits by allowing doctors to disclose medical errors without fear of admissibility in court
• Increasing the number of claims resolved prior to trial
• Tightening system to ensure that only meritorious malpractice lawsuits go to trial
• Reduces lawyers' fees from 25% for verdicts over $500,000 to 15% for verdicts over $600,000

Get everyone some form of catastrophic health coverage

FactCheck: Untrue that 47M uninsured want to “not play”

This idea--that most uninsured Americans simply don’t feel like having health insurance--is simply not the case: Most people who are offered insurance do not turn it down. A 2007 study found that 20% of the uninsured could have afforded coverage, but even leaving aside other factors like being turned down for insurance, that’s hardly 47 million people refusing to “play.”

Romney is also misleading when he implies that the uninsured are simply choosing between toeing the line and freeloading. While uninsured individuals can get a certain amount of free emergency care, it is by no means comparable to the care given to those with insurance.

Personal responsibility instead of employer mandates

A: Well, I actually got the job done. Working with people across the aisle, we said: Enough is enough. Look, the best kind of prevention you can have in health care is to have a doctor. And if someone doesn’t have a doctor, doesn’t have a clinic they can go to, doesn’t have health insurance to be able to provide the prescription drugs they need, you can’t be healthy. And you need to have health insurance for all of our citizens. And I found a way to do that without requiring raising taxes, without a government mandate, without a government takeover. When I said government mandate, I meant employer mandate. Instead, we have personal responsibility. We allowed individuals to buy their own policies. Those that couldn’t afford them, we helped them buy their policies. And you know what? It cost us no more money to help people buy insurance policies that they could afford than it was costing us before, handing out free care.

Let states create their own private, market-based insurance

ROMNEY: First of all, I’m not going to give the Democratic legislature credit for the plan that I helped build. I think it’s a model that other states can adopt in some respects. But our plan is different than Hillary Clinton’s in a lot of important ways. For Democrats, they want to have government take it over. The right answer is to get all of our citizens insured so they don’t have to worry about losing their insurance if they change jobs or have a preexisting condition. But Hillary says the federal government’s going to tell you what kind of insurance, and it’s all government insurance. And I say no, let the states create their own plans, and instead of government insurance, [have] private, market-based insurance. Hillary’s plan costs an extra $110 billion. My plan doesn’t cost any additional money.

Same tax treatment if people buy insurance without employers

Conservative idea: individual responsibility for health care

• On American Healthcare: “The wonders of America--like our healthcare technology--can be powerful tools to promote the foundations of liberty. It is time that we apply these American wonders to make the world, and in turn to make America, a safer, freer, and more prosperous place.”
• On Insurance for All: “We can’t have as a nation forty million people--or, in my state, half a million--saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay. It’s a conservative idea, insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.“
• When asked to compare his program with that proposed by then-First Lady Hillary Clinton: ”Perhaps the biggest between our two plans was that mine got passed and hers didn’t.“

Insure 45 million uninsured with a free-market based system

Pharmaceutical companies create products to make us better

And are there excesses? I’m sure there are, and we should go after excesses. But they’re an important industry to this country. But let me note something else, and that is the market will work. The buyer doesn’t have information about what the cost or quality is, or different choices they could have.

Subsidies for health coverage for low-income individuals

Voluntary purchasing pools

• Favored creating voluntary purchasing pools through which small businesses and individuals could buy insurance
• Pledged to cut health care costs through market-based reforms such as providing information on the price and quality of health care services to consumers.

ObamaCare has unelected board making health decisions

OBAMA: The irony is that we've seen this model work really well in Massachusetts, because Gov. Romney set up what is essentially the identical model.

ROMNEY: We didn't put in place a board that can tell people ultimately what treatments they're going to receive.

OBAMA: This "unelected" board is a group of health care experts to figure out, How can we reduce the cost of care in the system overall?

ROMNEY: To bring the cost of health care down, we don't need to have a board of 15 people telling us what kinds of treatments we should have. We instead need to put insurers, hospitals, doctors on target such that they have an incentive: performance pay, for doing an excellent job, for keeping costs down.

OBAMA: This board that we're talking about can't make decisions about what treatments are given. That's explicitly prohibited in the law.

ObamaCare is too expensive, and it has killed jobs

ROMNEY: I sure do. It comes from my experience. The number of small businesses I've gone to that are saying they're dropping insurance because they can't afford it, the cost of health care is just prohibitive. So it's expensive. Second reason, it cuts $716 billion from Medicare to pay for it. I want to put that money back in Medicare for our seniors. Number three, it puts in place an unelected board that's going to tell people ultimately what kind of treatments they can have. Fourth, small businesses were asked, what's been the effect of Obamacare on your hiring plans? And 3/4 of them said it makes us less likely to hire people. I just don't know how the president could have come into office, facing 23 million people out of work, rising unemployment, an economic crisis, and spend his energy and passion for two years fighting for ObamaCare instead of fighting for jobs for the American people. It has killed jobs.

State targets for insurance, to replace ObamaCare

A: I would repeal all of ObamaCare and replace it with I think the kinds of reforms we really need. Now and then the President says I'm the grandfather of ObamaCare. I don't think he meant that as a compliment, but I'll take it. I'm proud of the fact that in my state, after our plan was put in place, every child has insurance, 98% of adults have insurance, but we didn't have to cut Medicare by $716 billion to do that. We didn't raise taxes on health companies by $500 billion as the President did. And so we crafted a program that worked for our state, and I believe the right course for healthcare 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 with inflation, plus 1%, and you as the states are now going to be given targets to move people towards insurance and you craft programs that are right for your state. Some will copy what we did; others will find better solutions.

ObamaCare drives medical device jobs overseas

Obama cut Medicare by $500B to pay for ObamaCare

A: You've got to have the facts on your side. When Obama runs ads saying you are throwing the elderly over the cliff, I will say shame on you Mr. President; you are the only president in history to cut Medicare by $500 billion. And why did you cut it? To pay for Obamacare that we don't want and we can't afford.

Romney healthcare stances compared to Obama

Romney vs. Obama on Domestic Issues

• Alternative Sentencing
• Death Penalty
• Gun Rights
• Drugs in Society
• Marijuana Legalization
• Nuclear Waste
• Environmental Philosophy
• Emissions Standards
• Energy Efficient Cars
• Infrastructure Investment
• Outer Space Policy
• R&D Spending
• Health Mandate
• Medicare
• ObamaCare

Return healthcare to states, under the 10th Amendment

ROMNEY: One, I didn't send a team to meet with Obama. I wish he'd have given me a call. I wish when he was putting together his health care plan, he'd have had the judgment to say, "Let me talk to a governor who understands this topic," and get on the phone. I'd have said, "Mr. President, you're going down a very, very bad path. Do not continue going down that path because what you're going to do is you're going to raise taxes. You're going to cut Medicare." The plan we put in place in Massachusetts deals with the 8% of our people who didn't have insurance. The 92% of people who did have insurance, nothing changes for them. If I'm President, we're going to get rid of ObamaCare and return, under our Constitution--the 10th Amendment--the responsibility and care of health care to the people in the states.

No FEDERAL individual mandate; but state mandate ok

ROMNEY: If the people of Massachusetts don't like our plan, they can get rid of it. Individuals under the 10th Amendment have the power to craft their own solutions. I'm absolutely adamantly opposed to ObamaCare. It's a 2,000-page bill that takes over health care. It is wrong for health care. It's unconstitutional.

PERRY: I read your first book and it said that your mandate in Massachusetts should be the model for the country. It came out of the reprint of the book. But, I'm just sayin', you were for individual mandates.

ROMNEY: You've raised that before, Rick. And you're simply wrong.

PERRY: It was true then. It's true now.

ROMNEY: Rick, I'll tell you what. $10,000 bet?

PERRY: I'm not in the betting business. I'll show you the book.

ROMNEY: I wrote the book. Chapter seven is called The Massachusetts Model. I have not said anything about our plan being a national model imposed on the nation.

ObamaCare waivers on Day One; repeal bill on Day Two

ROMNEY: Rick, you're absolutely right. On day one, granting a waiver to all 50 states doesn't stop in its tracks entirely ObamaCare. That's why I also say we have to repeal ObamaCare, and I will do that on day two with a reconciliation bill, because, as you know, it was passed by reconciliation, 51 votes. We can get rid of it with 51 votes. We have to get rid of ObamaCare and return to the states the responsibility [for healthcare]. We all agree about repeal and replace. I put together a plan that says what I'm going to replace it with: to solve the problem of health care, to get it to work like a market.

ObamaCare has enormous differences from RomneyCare

ROMNEY: First, I'd be careful about trusting what President Obama says as to what the source was of his plan, number one. But number two, if you think wha we did in Massachusetts and what President Obama did are the same, boy, take a closer look, because:

• Number one, he raised taxes $500 billion, and helped slow down the U.S. economy by doing it. We didn't raise taxes.
• He cut Medicare by $500 billion. This is a Democrat president. The liberal, so to speak, cut Medicare. Not Republicans, the Democrat.
• We dealt with the people in our state that were uninsured, some nine percent. His bill deals with 100 percent of the people.
• He puts in place a panel that ultimately is going to tell people what kind of care they're going to have. We didn't do anything like that.
• What the president did was simply wrong. It is the wrong course for America. It is not what we did in Massachusetts.

On Day One, ObamaCare waivers to all 50 states

ROMNEY: One thing I'd do on day one if I'm elected president is direct my secretary of health and human services to put out an executive order granting a waiver from Obamacare to all 50 states. It is bad law, it will not work, and I'll get that done on day one. Now, what we faced in our state is different than what other states face. In our state, our plan covered 8% of the people, the uninsured. One thing I know, and that is that what Pres. Obama put in place is not going to work. It's massively expensive. His plan is taking over 100% of the people, and the American people don't like it and should vote it down.

ObamaCare's biggest difference: I believe in 10th Amendment

PAWLENTY: Obamacare was patterned after Mitt's plan. And for Mitt or anyone else to say that there aren't substantial similarities or they're not essentially the same plan, it just isn't credible.

ROMNEY: There are some similarities between what we did in Massachusetts and what President Obama did, but there are some big differences. And one is, I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people. We put together a plan that was right for Massachusetts. The president took the power of the people & the states away from them and put in place a one-size-fits-all plan. It's bad law. It's bad constitutional law. It's bad medicine. And if I'm president, on my first day, I'll direct the secretary of HHS to grant a waiver from Obamacare to all 50 states

MA Constitution allows mandate; US Constitution does not

A: You're asking me, what do we think we should do about Obamacare? And the answer is, I think you have to repeal Obamacare, and I will, and I'll put in place a plan that allows states to craft their own programs to make those programs work.

Q: I'm asking you where you find that authority in the Constitution.

A: Are you familiar with the Massachusetts constitution? I am. And the Massachusetts constitution allows states, for instance, to say that our kids have to go to school. It has that power. We said, look, we're finding people that can afford health insurance, that are going to the hospital and getting the state to pay for them--people who are free riders. We said, you know what? We're going to insist that those people who can afford to pay for themselves do so. That was our conclusion

ObamaCare's power grab won't work; Obama didn't ask me

PAWLENTY: I cited Obama's own words that he looked to Massachusetts as a blueprint or a guide when he designed Obamacare.

Q: You chose those words, "Obamneycare," on "Fox News Sunday;" why is it not "Obamneycare" with Romney right here?

PAWLENTY: Using the term "Obamneycare" was a reflection of the president's comments that he designed Obamacare on the Massachusetts health care plan.

ROMNEY: My guess is the president is going to eat those words and wish he hadn't put them out there. And I can't wait to debate him & say, Mr. President, if, in fact, you did look at what we did in Massachusetts, why didn't you give me a call and ask what worked & what didn't? And I would have told you, Mr. President, that wha you're doing will not work. It's a huge power grab by the federal government. It's going to be massively expensive, raising taxes, cutting Medicare. It's wrong for America. And that's why there's an outpouring across the nation to say no to Obamacare.

I care about 100% of people; & insured 98% of adults in MA

RomneyCare was bipartisan; ObamaCare was pushed through

ROMNEY: I like the way we did it in Massachusetts. In my state, we had Republicans and Democrats work together. What you did instead was to push through a plan without a single Republican vote. As a matter of fact, when Massachusetts did something quite extraordinary--elected a Republican senator to stop ObamaCare, you pushed it through anyway. So entirely on a partisan basis, instead of bringing America together and having a discussion on this important topic, you pushed through something that you and Nancy Pelosi and Harry Reid thought was the best answer and drove it through. What we did in a legislature 87% Democrat, we worked together; 200 legislators in my legislature, only two voted against the plan by the time we were finished. What were some differences? We didn't raise taxes. You've raised them by $1 trillion under ObamaCare.

RomneyCare is national model, but only state by state

OBAMA: Governor Romney said this has to be done on a bipartisan basis. [ObamaCare] was a bipartisan idea. In fact, it was a Republican idea. And Governor Romney said "what we did in Massachusetts could be a model for the nation." I agree that the Democratic legislators in Massachusetts might have given some advice to Republicans in Congress about how to cooperate, but the fact of the matter is, we used the same advisers, and they say it's the same plan.

ROMNEY: The right answer is not to have the federal government take over health care and start mandating to the providers across America. That's the wrong way to go. The federal government taking over health care for the entire nation and whisking aside the 10th Amendment, which gives states the rights for these kinds of things, is not the course for America to have a stronger, more vibrant economy.

2006: individual mandate is a Republican approach

The Heritage Foundation, a conservative think tank. In the late 1980s, when Democrats were pushing to require employers to provide health insurance, the Foundation suggested that every American be required to buy health insurance, a requirement known as the individual mandate.

Which politicians took up that idea?

Many Republicans did in the early 1990s, after Pres. Clinton introduced a plan that would have forced companies to cover employees. When the Clinton plan collapsed in 1994, talk of the individual mandate died with it. But a decade later, Mitt Romney, then governor of Massachusetts, resurrected the concept for his state health-care plan, which requires residents to buy insurance or pay up to $1,212 in annual penalties. "It's a Republican way of reforming the market," Romney said when the law debuted, in 2006. "To have people show up at a hospital when they get sick, and expect someone else to pay, that's a Democratic approach."

Over 98% of MA residents now have healthcare

There are important differences between the programs developed by Romney and those that Obama attempted to adapt on a federal level. For instance, Romney's plan passed the "state's rights" litmus test. It sought only to provide insurance to the uninsured. Romney's plan was not funded by new taxes. Nor did it employ "robbing Peter to pay Paul" tactics. Obama's plan brought new taxes and extracted money from Medicare.

2008: Individual mandate ok; free ride is not

Two years later when Obama used the Massachusetts plan as the model for a national health care program, Romney argued that "what works in one state is not going to work somewhere else." Many thought he was abandoning support for the Massachusetts plan, when in fact he was only saying, as he had said all along, that the health care plan could be implemented throughout the nation, presumably state by state. That is the only major difference: it should be a state program, not a federal one.

My plan right for MA but wrong for rest of country

Sifting through the chaff, careful listeners may have gleaned a few kernels of important information. Chief among them was Romney's legitimate concern that Obama's federal program, modeled on the one Romney built in Massachusetts, would likely lead to the creation of a sprawling and unresponsive bureaucracy.

Columnist and blogger Ezra Klein wrote: "His argument boils down to 'Under a Romney presidency, no state would have to replicate my awesome, obvious health-care reforms.'"

RomneyCare intended as state plan; never as national model

ROMNEY: I actually wrote my book, and in my book I said no such thing. When I put my health care plan together, a Washington Post reporter asked, "Is this is a plan that if you were president you would put on the whole nation, have a whole nation adopt it?" I said, "Absolutely not. This is a state plan for a state, it is not a national plan." And it's fine for to you retreat from your own words in your own book [on Social Security's constitutionality], but please don't try and make me retreat from the words that I wrote in my book. I stand by what I wrote. I believe in what I did. And I believe that the people of this country can read my book and see exactly what it is.

In MA, we addressed only the 8% who were uninsured

ROMNEY: I don't think he knows what he was talking about in that regard. Let me tell you this about our system in Massachusetts: 92% of our people were insured before we put our plan in place. Nothing's changed for them. The system is the same. They have private market-based insurance. We had 8% of our people that weren't insured. And so what we did is we said let's find a way to get them insurance, again, market-based private insurance. We didn't come up with some new government insurance plan. Our plan in Massachusetts has some good parts, some bad parts, some things I'd change, some things I like about it. It's different than Obamacare. Obamacare intends to put someone between you and your physician. It must be repealed. That law is bad; it's unconstitutional; it shall not stand.

I stand by what I did in Massachusetts

ROMNEY: Absolutely. I'm not running for governor. I'm running for president. And if I'm president, on day one I'll direct the secretary of Health and Human Services to grant a waiver from Obamacare to all 50 states. It's a problem that's bad law, it's not constitutional. I'll get rid of it.

Q: [to Perry]: Can a state like Massachusetts go ahead and pass health care reform, including mandates? Is that a good idea, if Massachusetts wants to do it?

PERRY: Well, that's what Gov. Romney wanted to do, so that's fine. But the fact of the matter is, that was the plan that President Obama has said himself was the model for Obamacare. I don't think it was right for Massachusetts when you look at what it's costing the people of Massachusetts today.

ROMNEY: If you think what we did in Massachusetts and what Pres. Obama did are the same, boy, take a closer look: he raised taxes $500 billion; we didn't raise taxes.

If people of MA don't like RomneyCare, they can change it

ROMNEY: If I'm elected president, I will repeal Obamacare. And also, on my first day in office, I will grant a waiver to all 50 states from Obamacare. Now, there's some similarities and there are some big differences. Obamacare spends a trillion dollars. If it were perfect--and it's not perfect, it's terrible--we can't afford more federal spending. Secondly, it raises $500 billion in taxes. We didn't raise taxes in Massachusetts. Third, Obamacare takes $500 billion out of Medicare and funds Obamacare. We, of course, didn't do that. And, finally, ours was a state plan, a state solution, and if people don't like it in our state, they can change it. That's the nature of why states are the right place for this type of responsibility. And that's why I introduced a plan to repeal Obamacare and replace it with a state-centric program.

2006 lessons: involve everyone; demonize none; transparency

People without insurance already receive care via E.R.

Massachusetts insurance regulations also didn't help. The commonwealth required insurers to offer only benefit-rich policies--and consequently, such policies were very expensive. Further, the state didn't allow insurers to adequately discount policy premiums for young healthy people. As a result, premiums for individuals who were not part of a pool were excessively high, & young healthy people declined to pay for them.

2006: Compromise with Ted Kennedy to make RomneyCare reality

1. Those who could afford insurance would either buy it pay their own health-care costs--no more free riders showing up at the hospital expecting to ge care at tax-payers' expense
2. For those who couldn't afford health insurance on their own, the state would pay a portion of their premium with the amount of the subsidy determined on a sliding scale by income
3. To make it easier to insurers to service individual customers, the state would create a "connector" or "exchange" that would collect premiums and pass them on to the insurers.

Base health care system on free choice & private medicine

Mandating citizens to buy health insurance is conservative

FactCheck: MA employers have no mandates, but “requirements”

Massachusetts may not call its rules for employers a “mandate,” but the state health care plan includes several “obligations” or “requirements,” as the state dubs them, for employers, along with fees for noncompliance. The requirements for employers are much narrower than those for individuals, who indeed, according to the state, face a “mandate” to get health insurance.

But is a “requirement” a “mandate”? You be the judge: Employers with more than 10 full-time employees must pay at least 33% of employee premium costs or have a group health plan. Those that fail to do so must pay a fee of $295 per full-time employee per year.

Individuals in the state must have health insurance. If not, they’ll lose their personal exemption on state income taxes in 2007--a penalty of $219.

FactCheck: No, MA healthcare plan is not paid for, yet

The Massachusetts Taxpayers Foundation estimated that the state would need an extra $200 million each year for 2007 to 2009 to finance the health care plan, because more people enrolled in subsidized care than anticipated. That shortfall, however, is a projection, and a Boston Globe article on the budget gap said some money could be shifted from the free care fund, if there is money in that fund to do so. Additional dollars came from a Medicaid waiver granted by the federal government, which is set to expire in 2009. The Massachusetts government is negotiating with federal officials to renew that waiver.

Removing most mandates drove down premium cost by half

ROMNEY: We took as many mandates out as we could in our policies. And the legislature kept some there. I tried to take them all out; they put some back in. It was a compromise. They put some mandates there. But, let me tell you how many we got out. The price of the premium for an individual, 42 years old, in Boston, used to $350 a month. Now, it’s $180. We basically cut it in half by deregulating. Congressman, you’re absolutely right that taking regulation out of insurance brings the price down, and that’s why my plan would go state by state, deregulate them so we can get the cost of premiums down. We got the job done.

FactCheck: HillaryCare closer to RomneyCare than “all gov’t”

• They both require that individuals obtain insurance and also require employers provide it.
• They both provide government subsidies for those with low incomes.
• Both expand the number of people covered under Medicaid.

FactCheck: MA plan works, but Romney not proposing it for US

It’s also unclear how many of the previously uninsured have gained coverage under the Massachusetts plan. While the program has successfully enrolled 200,000 people, some of those may have switched from less desirable policies. A more apples-to-apples measure found that 395,000 people didn’t have insurance in the state in 2006, then a 10% decrease in the uninsured through July 2007.

Get everybody insured with state-based market dynamics

1. We’re going to have states create their own plans. We did it in our state, and it’s working. We’re not going to have the federal government tell them how to do it.
2. We’re not going to spend more money. Hillary Clinton’s plan costs $110 billion. Mine says, let’s use the money we’re already spending a little more wisely.
3. Instead of having the federal government give you government insurance, Medicare and federal employee insurance, let’s have private insurance.

MA plan blends personal responsibility & universal coverage

Here’s a crash course in the 2006 Health Reform Statute. Every person is required to buy health insurance. Young, healthy people--who ordinarily wouldn’t buy health insurance--have to get it, even if they feel like they don’t need it. This inclusiveness lowers the premiums and allows state funds that were earmarked for medical care for the uninsured to be used to provide insurance for the populace. Medicaid still covers the indigent.

Critics say this isn’t fair to require everyone to buy health insurance. But it’s as equitable as requiring all drivers to buy automobile insurance. Everybody pays for the uninsured anyway, whether it’s in higher auto insurance premiums or higher hospital bills. Health insurance as a civic duty is a noble concept, but one that just may work.

FactCheck: Romney plan virtually identical to Obama plan

There are two problems with Romney’s characterization: One, Ohio Rep. Dennis Kucinich is the only Democratic candidate to propose a single-payer, wholly government-funded health care plan. And two, Romney’s Massachusetts universal insurance system bears a striking resemblance to the health care proposals of the Democratic front-runners. For example, the Obama and Romney plans are virtually identical. But in our view, the term “government takeover” could only be applied to Rep. Kucinich’s proposal.

MA program relies on personal responsibility & the market

A: As governor, I talked to people, and they say, “If I lose my job, I’m worried I’ll lose my insurance, and my insurance premiums are getting higher and higher.” And we said: We got to find a way to get everybody insured. And the last thing we want is to have the government take over health care, because anything they take over gets worse. We said: We need to find a way to get everybody in our state insured with private insurance. [We found] a way to get them insured without raising taxes, without a government takeover. It relies on personal responsibility. Every Democrat up there’s talking about a form of socialized medicine, government takeover, massive tax increase. I’m the guy who actually tackled this issue. We get all of our citizens insured. We have to stand up and say the market works. Personal responsibility works.

MA health plan insures all without taxes or socialization

A: I love it. It’s a fabulous program. I’m delighted with the fact that we worked together across the aisle, Republicans and Democrats, to find a way to get health care for all of our citizens that’s affordable and that’s portable. I helped write it and I knew it well, and this is a country that can get all of our people insured with not a government takeover, without Hillarycare, without socialized medicine. Instead, get the market to do its job. Let me people have health care that they can afford. Get the market to do its job. Let people have the opportunity to choose policies in the private sector. We didn’t expand government programs. We didn’t raise taxes. There was no government takeover.

FactCheck: MA plan not yet in place so analysis premature

Overall, it’s too soon to tell how successful the Massachusetts plan will be. The requirements for health coverage do not go int effect until July. By April, nearly 70,000 people had signed up for subsidized health plans. That number is half of those eligible. But the total estimate of uninsured Massachusetts residents is 372,000. The state has a long way to go.

And it has hit some snags in implementing the law. The initial bids from insurance companies were much more expensive than what Romney had touted, because over 200,000 insured residents would need to buy additional coverage to meet the original state requirements.

Signal accomplishment as Governor is MA insurance reform

MA reform focuses on individual responsibility (via fines)

In fact thousands of those risk-takers end up needing health care, and of the expensive sort. The state and the care providers eat the costs, which means the taxpayer and premium payers eventually get the bills. To this group, Romney gives no choice. In January, 2008, they must either insure themselves or be subject to a fine. The poor get subsidies as well as assistance in signing up.

The legislature tacked on a provision that penalizes companies of 11 or more employees that do not provide health insurance. Romney vetoed this add-on. The legislature overrode his veto. But the lawmakers still handed Romney an enormous victory. They did so because the plan manifestly makes sense.

State universal coverage plan is national test case

The program’s passage with overwhelming bipartisan support is a notable achievement. It remains to be seen how many uninsured people actually order policies. Romney remarked, “I wish I were going to be governor the next five years to see it through,” but he will step down at the end of this year and is preparing to seek the presidency. Meanwhile, his health plan gives him a unique calling card-and provides the country with an important opportunity to test one possible solution to a vexing problem.

MA state health insurance plan lowered costs

Mandates on health insurance work in Massachusetts