Romney’s Real Health Reform Goals vs. Romneycare

Kate Nocera has an interesting report about something Mitt Romney has tried to claim for some time — that is, the health care reform he envisioned is actually quite different than the legislation he ultimately signed into law as governor of Massachusetts. In other words, pure Romneycare is far more market driven than the Massachusetts law and, by extension, the Affordable Care Act:

Romney wanted a lighter mandate, with a way to get out of it if people were willing to pay something upfront to cover them in catastrophic events. He didn’t want to cover as many benefits. And he didn’t want to expand Medicaid at all.

His vision was never going to fly in the liberal state — so he signed a much different version into law, often described as a framework for what was to come. But his original plan shows that his own ideas were more market-driven, with fewer required benefits for health plans and no mandate for small businesses to offer health insurance.

So when Romney says he wants health care to work more like a market, there’s actually more of a record behind his rhetoric than the final Massachusetts law suggests.

That argument would carry more weight if Romney hadn’t embarked on a national media tour following the passage of the law to highlight his success in reaching across the aisle and working with Democrats to produce a compromise measure both sides could agree on. As he put it in 2006, “I must admit that I’m pleased with the fact that here in a state that’s overwhelmingly Democratic, a Republican governor can introduce a plan to get everybody insured, work collaboratively with the Democratic legislature, combined with the administration in Washington and our delegation there to come up with a plan to get the job done.”

Still, Romney is correct on the details. Both he and the Heritage Foundation advocated a “personal responsibility” requirement in which families and individuals who did not purchase coverage would be required to spend $10,000 in the form of a bond that could be used to pay for hospital care down the road. To Romney, this idea ensured funds were directed back into health care rather to the government revenue. But charging a flat fee regardless of income means different things to different economic demographics and would have significantly disadvantaged middle class families — who would have had to set a side a huge amount of money for a rainy day. The mandate penalty in the Affordable Care Act takes some of these affordability concerns into account and requires those without coverage to pay a tax penalty of the greater of $695 per year or 2.5 percent of household income.