Mitt Romney typically promises to send the Medicaid program — a federal-state partnership that provides health care to the neediest Americans — back to the “states,” with a significantly reduced federal contribution. But this morning, during a rally in Harrisburg, Pennsylvania the former Massachusetts governor went even further, promising to let individuals deal with skyrocketing health care costs and access problems on their own:
ROMNEY: I want to return health care to the states. I will repeal Obamacare and let people have responsibility for their own health care.
Setting aside the hypocrisy of Romney’s “personal responsibility” advocacy — he, after all, would repeal a law that would require all able bodied Americans to take control of their own health care spending — it’s hard to believe that states can deal with the health care crisis on their own. Sure, a place like Massachusetts, which already enjoyed high insurance rates, can try to pass a universal coverage plan, but few others can — and no others have.
In fact, the history of state-based health care reform efforts is filled with false starts and dashed hopes, from California to Hawaii to Oregon, suggesting that the lessons from one state tend to be just that—applicable to one but not the rest. State uninsured rates vary greatly from just under 3 percent to almost 25 percent and, generally, where rates are the highest (i.e. Texas), governments have the least resources in terms of a tax base to support funding for needed coverage expansions or provide subsidies to their populations. Balance budget requirements also prevent many states from making meaningful long-term investments in reform and powerful health care industry lobbyists often stand in the way of reforms that could reduce industry profits. Recessions also complicate the process, as governors and legislators often have to cut health care programs, just as their enrollment skyrockets and state costs increase.
So as Romney well knows, the system is simply stacked against state efforts. It’s a shame that he’s now pretending otherwise.