Texas Gov. Rick Perry (R) likened Mitt Romney’s Massachusetts health care law to socialism during a speech at the Iowa Credit Union League in Des Moines, Iowa this afternoon, saying, “the model of socialized medicine has been tried before…whether it was in Western Europe or in Massachusetts”:

PERRY: In Massachusetts the costs have increased by more than $8 billion, that’s what that socialized individual mandated health care bill they put in place in Massachusetts did. Those who had insurance are now paying the price for an individual mandate for those without insurance who must join the system. Private insurance premiums in that state have gone up by more than $4 billion. The problem with state-sponsored health care is if you cannot contain it just within the borders of your state.

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Perry’s comparison about the mandate is ironic, since he signed an executive order mandating young girls to receive vaccinations for HPV, a sexually-transmitted disease that causes cervical cancer. The document — which Perry has since distanced himself from — specifically uses the word “mandate”: “The Health and Human Services Executive Commissioner shall adopt rules that mandate the age appropriate vaccination of all female children for HPV prior to admission to the sixth grade,” it read.

The mandate to obtain health insurance was first introduced by congressional Republicans as an alternative to then-First Lady Hillary Clinton’s health care reform bill in the 1990s. The individual mandate was developed by the conservative Heritage Foundation and supported by many prominent Republicans as recently as 2009. Romney has consistently described the provision — which requires individuals to take responsibility for their health insurance coverage — as the “ultimate conservative plan.” “I know some people say, ‘gee, your Massachusetts health care plan isn’t conservative.’ I say, ‘oh yes it is, because right now in this country people who don’t have health insurance go to the hospital if they have a serious illness and they get treated for free by government,” he told CNN in 2007. “My plan says no they can’t do that, no more free riders. People have to take personal responsibility.”

Ultimately, the Texas governor — whose state has the highest uninsurance rate in the nation and the second-highest health care premiums — can criticize Massachusetts and “Western Europe” all he wants. The truth is, the Bay State has expanded coverage to almost all residents, successfully contained spending for the newly insured population and lowered government expenditures on uncompensated care, while European countries already spend far less of their Gross Domestic Product (GDP) on health care and provide universal access to all of their citizens.

During a GOP presidential debate at the Reagan Library earlier this month, Rick Perry blamed the federal government for Texas’ high uinsurance rates and health care costs, claiming, “we would not have that many people uninsured in the state of Texas if you didn’t have the federal government.” “We’ve had requests in for years at the Health and Human Services agencies to have that type of flexibility where we could have menus, where we could have co-pays, and the federal government refuses to give us that flexibility,” he added.

But yesterday, Texas received a thumbs up from the Obama administration “on a proposed overhaul of the Texas Medicaid program” that would allow Perry “to expand Medicaid managed care across the state and create funding pools to finance hospital infrastructure and quality improvement programs.” If the federal government grants its final approval, it will be the state’s 17th Medicaid waiver, undermining Perry’s argument that the federal government has prevented Texas from pursuing “innovating” health care solutions.

GOP lawmakers from Kansas and Oklahoma want to use funds granted by the Affordable Care Act to help pay down the deficit, instead of reducing the number of Americans without health insurance. Both states applied for “early innovator grants” to experiment with technology for the law’s new health insurance exchanges, were awarded the money, but ultimately rejected it. Now, Reps. Jim Lankfordand (R-KS) and Mike Pompeo (R-OK) have introduce a bill to use the funds to pay down the deficit:

“Simply giving the money back to the Obama administration to be spent elsewhere is not acceptable in light of our current debt situation,” Pompeo said. [...]

“Kansas and Oklahoma have sent a clear signal to this administration that they reject its strings-attached funding,” said Pompeo, who was not in Congress when lawmakers voted on health care but opposes the measure. “Let’s use these funds to pay down our deficit.”

McClatchy reports that the entire Kansas and Oklahoma House delegations have already signed on to the proposal.

The grant money — $31.5 million for Kansas and $54 million for Oklahoma — will have essentially zero impact on the deficit. The combined $85 million represents about one 16,000th of the $1.4 trillion deficit. On the other hand, the grants would help develop technologies for the insurance exchanges, allowing Americans who are unemployed, self-employed, or work somewhere that doesn’t offer coverage to enroll in affordable insurance. Unfortunately, as in other states, Republicans seem interested in making a political statement, despite that fact that it will adversely affect the 347,400 and 578,500 uninsured residents in Kansas and Oklahoma, respectively.

During an appearance on CNN’s Situation Room yesterday, Mitt Romney responded to questions about why he took out the suggestion that Massachusetts’s health care reform law could be applied to the nation from an updated version of his book, No Apology. In the hardcover edition, Romney wrote, “We can accomplish the same thing for everyone in the country, and it can be done without letting the government take over health care,” but the sentence was omitted from the paperback issue.

“We updated the book because it came out almost a year after the first book and of course the president’s plan was then put in place,” Romney explained. “I was asked when we put our plan together, by Dan Balz of the Washington Post, ‘Is the plan in Massachusetts something that if you are president, you’d have the entire country adopt?’ And I said no. I said that very clearly. I’ve said it throughout 2008. The Massachusetts plan was crafted for Massachusetts.”

But Romney is wrong — after signing reform into law in 2006, he repeatedly argued that his plan could serve as a model for the nation as a whole and the states individually. For instance, in the article by Dan Balz from Nov. 26, 2007 Romney said, “I was just across the country this week talking about my plan. I’m very proud of my health-care plan and think it should be a model for other states to adopt.” Other examples:

– “How much of our health-care plan applies to other states? A lot. Instead of thinking that the best way to cover the uninsured is by expanding Medicaid, they can instead reform insurance.” [WSJ, 4/11/2006]

– “There are certain aspects of it that I think would work across the country, perhaps better in some states than others. Of course the great thing about federalism is you let a state try it and see how it works before you spread it out. [MSNBC, 4/12/2006]

-– “And there may be some aspects of it that can be picked up by other states and that would be valuable for other states, perhaps even some national elements that could be adopted…Everybody in our state has to have health insurance. We`re not going to have free riders — people who can afford to buy insurance, but who decide instead just to show up at the hospital and get free care. And that`s a model which I think has some merit more generally.” [PBS, 6/5/2006]

-– “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be a model for the nation.” [Newsweek, 12/2/2007]

The paperback version of No Apology also emphasized the changes he would have made to the plan and how it’s different from “Obamacare.” “First, of course, I would reinstitute my vetoes of the legislature’s additions,” Romney writes in the paperback version, stressing that he believes that the “state should not mandate which benefits must be included in health insurance policies.” He also says he would change the structure of the individual mandate to “provided a tax break for those who have health insurance rather than a tax penalty for those without health insurance.”

Nearly all Massachusetts employers are meeting the requirements of the state’s 2006 health care reform law and offering health insurance coverage, a new report released by the Massachusetts Division of Health Care Finance and Policy concluded: 95.4 percent of employers subject to the fair-share requirement provided coverage, down slightly from 95.9 percent in 2009. Under the measure signed by Mitt Romney, employers with 11 or more full-time equivalent employees (FTEs) must either make a “fair and reasonable” contribution toward the health care costs of its workers or pay a Fair Share Contribution (FSC) of up to $295 annually per FTE. (Note: Romney vetoed the employer responsibility provision, but it was overridden by the legislature.)

The trend assuages GOP predictions that employers would drop coverage if given a choice between paying a modest penalty and offering insurance, potentially undermining their claims that the Affordable Care Act’s employer responsibility provisions will encourages businesses to dump their employees into the exchanges. Since reform, the Massachusetts employer offer rate has increased to 77 percent, up from 72 in 2007. The national offer rate now stands at 69 percent.