Romney plays up -- and down -- Massachusetts health care experience
By Sarah Lueck and Mary Jacoby
Posted: August 24, 2007
Republican presidential hopeful Mitt Romney talks, Wednesday, Aug. 22, 2007, in Reno, Nev., about giving states more control over Western issues such as water, mining and public lands.
(AP Photo/Cathleen Allison)
As governor of Massachusetts, Mitt Romney won praise from liberals for expanding health-care coverage for the uninsured. Running for president, the Republican has been attacked by his party’s conservative base for the same plan.
Today, Mr. Romney will aim to reconcile his old record with his new campaign, unveiling a health-care proposal that nods to—but plays down—the Massachusetts experience and takes a much heavier free-market approach.
It doesn’t include the state plan’s mandates on companies to provide coverage. It largely provides tax incentives aimed at making it easier for individuals to find their own coverage.
The reason for the switch: “Massachusetts didn’t have the federal tax code to play with,” R. Glenn Hubbard, a top Romney economic adviser, said in an interview previewing today’s speech in Florida.
Health care is one of many areas where Mr. Romney has had to juggle the rhetoric he used to win office and govern in one of the nation’s most liberal states with the demands of campaigning for the nomination among conservative voters in Iowa and New Hampshire. In his failed Massachusetts Senate bid in 1994 and his successful run for governor in 2002, Mr. Romney took stances on issues such as abortion and gay rights that he now disavows.
Mr. Romney’s new focus on tax cuts for health care—and avoidance of mandates—also reflects big differences between Republican and Democratic voters on the issue. Mr. Romney follows another Republican contender, former New York City Mayor Rudy Giuliani, in pushing tax breaks as the main answer to covering the uninsured.
Meanwhile, Democrats John Edwards and Barack Obama have recently unveiled high price-tag national plans that rely heavily on new spending and new rules. Front-runner Hillary Rodham Clinton is expected to follow with a comprehensive plan soon. Yesterday in New Hampshire, she gave a speech touching on some of her proposals, including increasing federal subsidies for teaching hospitals and universities—and focusing them on providing doctors and nurses incentives to advance their skills—and creating a consumer database of providers’ performance records.
On the campaign trail, Mr. Romney is proposing an approach many Republicans in recent years have embraced—changing the tax code to spur more people to buy their own, private health insurance in the individual market. Most insured people get their coverage through employers, but others must turn to the individual market and buy their own plans. By proposing to make all medical expenses tax deductible, Mr. Romney is trying to improve a tax system that many Republicans say is skewed in favor of the group market.
Overall, the plan draws heavily on a 2005 book, “Healthy, Wealthy and Wise: Five Steps to a Better Health Care System,” that was co-written by Mr. Hubbard. He formerly ran President Bush’s Council on Economic Advisers and is now the dean of Columbia Business School.
The book’s ideas have been praised by many conservatives. “Compared to what Gov. Romney did in Massachusetts, that would be a dramatic improvement,” said Michael F. Cannon, director of health-policy studies at the Cato Institute. “If it’s geared toward getting government out of people’s health-care decisions by reforming the tax code, wow, that’s fantastic.”
Mr. Romney also proposes shaking up government funding of health care—primarily through the Medicaid program for the poor—and giving states more flexibility to design their own plans for covering more low-income people. Medicaid is funded jointly by the federal government and the states, and it is an open-ended program in which federal spending grows as costs rise and more people join. Mr. Romney calls for replacing the current federal funding with a block grant—an idea that is sure to prompt criticism from Democrats who fought a similar Republican plan in the 1990s. States also would be encouraged to improve their individual insurance markets, which they regulate, to help make policies more affordable.
“The plan is very much right out of the conservative playbook,” Mr. Hubbard said.
This summer, Mr. Giuliani proposed a plan also centered on private, individual health insurance. He backed a $15,000 tax deduction to encourage people to purchase their own coverage, as well as a tax credit for low-income people who wouldn’t benefit from the deduction.
Unlike Mr. Romney, Mr. Giuliani would limit the tax break to a set amount—a feature that appeals to some conservatives concerned about runaway tax breaks. Mr. Romney’s plan is broader, focusing more than Mr. Giuliani’s on regulatory changes aimed at reducing the cost of individual insurance policies. Both men plan to release further details about their health-care proposals in coming months.
It is clear their approaches are vastly different than the Democratic presidential candidates, who are more willing to rely on expansion of existing government health programs to help reduce the number of uninsured. They also have backed changes aimed at providing universal coverage—health insurance for all of the 45 million people estimated to lack it. Neither Mr. Romney’s nor Mr. Giuliani’s plan would achieve universal coverage. Many health-care advocates attack them for declining to seek that goal.
But Democrats are wrestling with how far they can go in pushing coverage without facing attacks for embracing “socialized medicine.” Mrs. Clinton—who was roundly criticized for her failed attempt at a national health-care plan 13 years ago—is most sensitive of all the candidates to those complaints.
So she has been moving cautiously toward laying out her main health-care plan, step by step. Yesterday in Lebanon, N.H., she talked about improving health-care quality, having earlier talked about saving costs.
At Dartmouth-Hitchcock Medical Center, where as first lady she kicked off her ill-fated effort to overhaul health care, she addressed about 200 health professionals, many of them in their white medical coats.
To applause, she said, “We have to completely overhaul our reimbursement system” so that Medicare and Medicaid payments to providers are tied to the quality and effectiveness of the care beneficiaries receive.