While the final health care reform law probably resembles the GOP’s 1993 health care plan closer than some of the more progressive alternatives Democrats proposed during the 2008 Presidential election, Republicans and their conservative allies have gone to great lengths to portray reform as a radical government takeover of health care. Organizations like the Heritage Foundation and politicians like Mitt Romney and Chuck Grassley, who have historically supported centrist reform provisions like the individual mandate, state-based exchanges and tax credits to help Americans purchase affordable coverage, are now abandoning their old positions and aligning themselves with conservatives who argue that health reform is unconstitutional. The shift is part of an election strategy designed to convince Americans that the new health care law is a left-wing to expand government control over the health care system.

President Obama, however, has repeatedly credited Heritage and Romney for providing the foundation for several reform provisions, placing some conservatives on the defensive. Just today, Robert Moffit of the Heritage Foundation attempted to distance his organization from national reform:

First, Heritage did not originate the concept of the health insurance exchange. Furthermore, the version of the exchange we did develop couldn’t be more different than that embodied in this law. For us, the health insurance exchange is to be designed by the states. It is conceived as a market mechanism that allows individuals and families to choose among a wide range of health plans and benefit options for those best suited to their personal needs and circumstances. People would have a property right in their health policy, just like auto or homeowners’ policies, and be able to take it with them from job to job. Under the Heritage design, individuals could choose the health plan they want without losing the tax benefits of employer-sponsored coverage. The exchange we propose would be open to all state residents and — very importantly — be free of federal regulation. [...]

For the record, we think that the law’s federal mandate is unconstitutional. Our legal center, led by former attorney general Edwin Meese III, notes that Congress has no authority to force an American to buy any good or service merely as a requirement of being alive.

Yes, in the early 1990s, we, along with other prominent conservative economists, supported the idea of such a mandate. It seemed the only way to solve the “free-rider” problem, in which individuals can, under federal law, walk into any hospital emergency room nationwide and rack up big bills at taxpayer expense.

Two things. First, it’s true that the exchanges and the individual mandate in the final health care law are different than Heritage would have liked, but that, after all is the nature of the political process. The final legislation is a collection of conservative and progressive ideas (more the former and the latter) and one can’t argue that modifying a conservative ideas renders it completely unrecognizable. The new health care law requires each state to establish its own exchange and gives states a great deal of flexibility in running, operating and regulating the new health insurance markets.

Second, Moffit’s claim that Heritage foolishly supported the individual mandate when it was part of a fad in the 1990s is just inaccurate. As Lee Fang points out, Heritage boosted Romney’s health reform plan as recently as 4 years ago, calling the individual mandate “Not an unreasonable position, and one that is clearly consistent with conservative values.”

The fact is, conservatives openly acknowledged the bipartisan nature of health care reform throughout 2009 and are now backing away from the law for purely political purposes. In September 2009, for instance, Rep. Eric Cantor (R-VA) told a town hall meeting that “Republicans and Democrats agree on 80 percent of fixing the nation’s healthcare system.” Rep.Charles Boustany (R-LA), who delivered the Republican response to the President’s congressional address in September, also said, “I would venture to say that we agree on about 80% of the issues right now. It’s just a matter of hashing out those few areas where we disagree, but there’s really not been that kind of real discussion, and it needs to happen.”

Andrew Romano forces Mitt Romney to explain why he continues to defend federal the Massachusetts health care plan while calling for the repeal of its federal cousin, ObamaCare. Romney’s argument boils down to this: health reform should be done on the state level with help from the federal government. “I reject the idea of a federal mandate imposed on states and individuals,” Romney tells Romano. “If instead one said at the federal level, ‘We’re going to give resource flexibility to states to use money they’re already receiving as a way to help the poor buy insurance,’ that says, “All right, we’re using funds that have already been allocated, we’re letting states create their own plans, and we’ll see how that works. And we’ll learn from the experience.”

But didn’t Romney suggest that the Massachusetts plan would be a model for the nation? He explains:

NEWSWEEK: Back in February 2007, you said you hoped the Massachusetts plan would “become a model for the nation.” Would you agree that it has?

ROMNEY: I don’t … You’re going to have to get that quote. That’s not exactly accurate, I don’t believe.

NEWSWEEK: I can tell you exactly what it says: “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be a model for the nation.”

ROMNEY: It is a model for the states to be able to learn from. During the campaign, I was asked if I was proposing that what I did in Massachusetts I would do for the nation. And the answer was absolutely not. Our plan is a state plan. It is a model for other states—if you will, the nation—it is a model for them to look at what we’ve accomplished and to better it or to create their own plans.

NEWSWEEK: There are obvious similarities between Obamacare and what you did in Massachusetts. Do you acknowledge that what you did in Massachusetts has become a model for nation under Obama, whether you wanted it to or not?

ROMNEY: I can’t speak for what the president has done. I don’t know what he looks at. He never gave me a call. Neither he nor any of his colleagues [gave me] a call to ask what worked and did not work, and how would they improve upon it and so forth. If what was done at the state level, they applied at the federal level, they made a mistake. It was not designed for the nation.

Let’s bend over backwards, ignore his long history of inconsistency, and give Romney the benefit of the doubt. Perhaps by “nation” he really means 50 different states. In that case, his argument would be the following:

1) Massachusetts reform is unique to Massachusetts.

2) The federal government should let the states reform their own systems as they see fit.

3) States can use the Massachusetts plan as a model, if they wish.

In short, there is no larger role for the federal government in health reform than giving states money to try different experiments. But if you consider this argument on its own merit, you quickly realize that their Romney’s “plan” would lead to serious national inequality and disadvantage the states that need reform the most.

Romney was able to pass and sign health care reform in 2006 because Massachusetts already enjoyed a relatively high insurance rate (10.7% uninsured in 2005, compared to 15.7% national average), a large tax base, robust state regulations and a fairly liberal electorate. Other states don’t have these advantages. Nationally, state uninsured rates “vary from just under 8 percent to almost 25 percent” and, the states with the least resources often have the highest uninsurance rates. They would be most disadvantages under Romney’s state-based approach because they don’t have the economic, political or structural capacity to invest in something as big as health care reform and their populations face more prevalent rates of obesity, diabetes and other expensive chronic conditions. Asking these states to take some federal dollars and just expand coverage (somehow) ignores the reality of state government (almost every state has to balance its budget every year) and the economic challenges states are facing in funding their existing health programs.

Romney’s approach may make for a good sound bite, but in reality it’s a Darwinian solution that would leave the poorest states with the most pronounced health crisis to fend for themselves. If this is really his position, then we should make him own it.