Tuesday, December 27, 2011

Question for Republicans

Okay, so now we know that not only did Romney consider his Massachusetts health insurance plan a national model, Gingrich* enthusiastically embraced it as a plan "tremendous potential to effect major change in the American health system," asserting that 100% of Americans should have health insurance and implying that the individual mandate was a linchpin to reaching that goal (I don't consider his spokesman's plaint that Newt didn't write the "Newt Notes" in question worth bothering about). As Ezra Klein reminds us, Obamacare is essentially a Republican scheme for delivering near-universal coverage: "insofar as the Republican Party had a plan for health-care reform, the individual mandate was it."

A question, then, for Republicans: When Romney's healthcare plan was news -- from, say, April 2006, when Romney signed his plan into law, until February 2007, when John Edwards came out with a national plan embracing the individual mandate -- was there any prominent Republican or conservative who went on record saying that Romneycare was an interesting and promising experiment, but that a similarly structured national plan would be inappropriate or unworkable?  Did any mainstream Republican or conservative suggest that an individual mandate imposed by the federal government would violate the U.S. Constitution?

*I don't consider the plaint by Newt's spokesman that Newt didn't write the "Newt Notes" in question any more exculpatory than Ron Paul's claim that he didn't know what was in the Ron Paul newsletters. If you're name's on it, and you disavow it, you're a self-confessed fraud.

UPDATE: I have found a libertarian critic of the individual mandate, writing in USA Today Magazine on July 1, 2006: Cato's Michael Tanner, a critic of "big government conservatism." Tanner argued that the individual mandate was unenforceable; that subsidized mandated insurance for individuals would be unpriceable; that minimum coverage standards would become a goody bag for providers of various health services; and that the individual mandate would lead to more government control of the healthcare system.  As prelude to his attack, Tanner noted that "proposals for an individual mandate have drawn a surprising degree of support from conservatives."
More broadly: I have spent some time reading coverage of health reform efforts and proposals from April 2006 through January 2007,  prior to John Edwards putting universal coverage on the national agenda in February 2007. To be fair, while Republicans in general did not express hostility to the individual mandate, there was a good deal of sentiment across the political spectrum to the effect that different states have different conditions and need to find their own way to healthcare reform; one criticism from that left was that in states that mandate less comprehensive coverage than Massachusetts and so have less robust health insurance providers, a mandate could saddle poor people with expensive subpar coverage. Also, funding conditions were favorable in Massachusetts, because a) a high percentage of state residents were covered by employer-provided health insurance, b) the state was able to use a Medicaid waiver worth hundreds of millions of dollars, which it would have lost if it did not reform its healthcare system, and c) the state was also able to tap a $600 million annual fund collected from healthcare providers to pay for care for the uninsured.  Of course, the Affordable Care Act addresses the problem of inferior state coverage standards by imposing universal minimum standards, and it also provide funding for the exchanges and for Medicaid expansion.  But that centralization does provide a target for federalist conservatives.

When Romney published an op-ed touting his program in the Wall Street Journal in fall 2006, he did not suggest federalizing it, but rather that it could serve as a model for other states: "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." Further, an article in State Health Watch, Aug. 2006, quotes Romney as follows:
Even Mr. Romney told members of the U.S. Chamber of Commerce that the plan was custom-made for his state's situation and unique circumstances, although other states could borrow some ideas. Because of high private insurance rates and an expansive Medicaid program, Massachusetts estimates only 7% of residents are uninsured, compared to a national average of 15%. Also, Massachusetts can subsidize premiums with funds other states don't have. It already spends $680 million in state and federal money to support hospitals serving the poor and that money will be redirected to buy insurance for lower-income residents.

"It's obvious in some respects that, if we could do it there, we could do it in other states," Mr. Romney said. "I believe that's true. I'm not sure it would be done in exactly the same way. Some of the principles we found to work in Massachusetts may well be applied in other states, others perhaps not."
On the other hand, health care expert Robert J. Blendon of the Kennedy School accurately forecast the effect of Romneycare in June 2006:
Mr. Romney will likely tout the law during his expected bid for the Republican presidential nomination in 2008, an achievement that will force Democrats to embrace the Massachusetts plan or something broader, Mr. Blendon said. But most Republican primary voters aren't concerned with health care issues, so Mr. Romney may have limited traction with the topic while campaigning in South Carolina, New Hampshire and Arizona, Mr. Blendon said.

Democratic primary voters do use health care as a touchstone, and anyone who offers less than the Massachusetts plan in their stump speech has little hope of gaining the nomination, Mr. Blendon said.

"No Democrat can be serious if they have a plan less than Romney's," he said. "He has raised the bar for the Democratic primary"  (Worcester Telegram & Gazette, 6/16/06).


  1. "Of course, the Affordable Care Act addresses the problem of inferior state coverage standards by imposing universal minimum standards..."

    I don't think universal minimum standards are in play any more.

  2. You wrote, in part, "Of course, the Affordable Care Act addresses the problem of inferior state coverage standards by imposing universal minimum standards..."

    But see, for example, http://www.kaiserhealthnews.org/stories/2011/december/16/essential-benefits-guidance.aspx

    "States will be given wide latitude to decide what “essential benefits” insurers must offer in their health policies come 2014, the Obama administration said Friday in a move that pushes off final federal rules on the topic until an unspecified date..."