the national interest

Romney’s Health Care Evasions: A History

TAMPA, FL - JANUARY 31: Republican presidential candidate, former Massachusetts Gov. Mitt Romney gestures during his Florida primary night party on January 31, 2012 in Tampa, Florida. According to early results Romney defeated former Speaker of the House Newt Gingrich, former U.S. Sen. Rick Santorum and U.S. Rep. Ron Paul (R-TX) to win Florida's primary. (Photo by Joe Raedle/Getty Images)
Photo: Joe Raedle/2012 Getty Images

Wednesday afternoon, Mitt Romney appeared on Fox News and was presented with yet another piece of evidence that he has misrepresented his health care position. Romney’s current line is that he has never advocated a national version of his Massachusetts health insurance program, and certainly not the health insurance mandate.

But that was not, in fact, Romney’s position in 2007 through 2009. Will Saletan has masterfully documented how Romney reversed his position on abortion and covered up his reversals, combining a sprinkling of outright lies with a heavy dose of carefully crafted evasions. He has used the same technique here on health care.

Romney, as we know, crafted a health care plan in Massachusetts that became the model for the Affordable Care Act. His position today is that Romneycare is a wonderful thing at the state level, but at the federal level it is socialism, and unconstitutional to boot. But during the 2008 campaign, when he introduced himself to the national Republican electorate, he took a much different position. The stark lines between the virtues of his state plan and the horrors of such a national version of such program were far more blurry. In characteristic fashion, he is revising his old position to bring it in conformity with his new one. 

Romney’s current description of his 2008 health care position is simple and concise: “I said, not national program, state by state program.” He did say that. But it does not actually mean very much. During the last election cycle, Romney didn’t have a very concrete health care plan. He had a collection of goals and buzzwords, proposing a series of goals, like universal coverage and cost control, without any specific means to achieve them.

In his quest to make himself the conservative’s conservative four years ago, Romney frequently touted the “federalist” and “state-by-state” character of his “plan,” which he used to distinguish it from Democratic schemes. But this is more of a framing device than a fundamental cleavage. After all, the Affordable Care Act can also be described as a “state-by-state” plan – it sets up a series of state-level exchanges where people can shop for private insurance.

Washington Post fact-checker Glenn Kessler has recently cited Romney’s calls for state-by-state plans as a reason to believe Romney’s claim that he hasn’t altered his position on the national mandate. Kessler’s endorsement has become a major bulwark of Romney’s current spin. Romney has cited Kessler’s column as proof that the attacks on him are false. Kessler’s reasoning is highly tendentious – he essentially argues that Romney’s belief in federalism in 2008 absolutely precluded requiring an individual mandate, and he ignores or downplays every other statement Romney has made to the contrary.

And many such statements exist. At the same time as he was proclaiming his love of federalism, Romney was also touting the features of his Massachusetts plan as the basis for his national plan. He did this so repeatedly that it was often impossible to tell where his defense of his Massachusetts program stopped and his explanation of his national plan began.

Romney has frequently cast the individual mandate in Massachusetts as a fundamentally conservative idea (it was invented by conservatives.) He describes it as a policy of promoting personal responsibility, stopping moochers from free-riding off government by foregoing health insurance and soaking up free care in the emergency room. He even touted the individual mandate to Glenn Beck as “the ultimate conservatism.” During that campaign, Romney often used these arguments to defend not only his state plan but his national plan as well. During a GOP debate in Iowa in August of 2007, he cited his Massachusetts plan as if it were his national plan:

We have to have our citizens insured, and we’re not going to do that by tax exemptions, because the people that don’t have insurance aren’t paying taxes. What you have to do is what we did in Massachusetts. Is it perfect? No. But we say, let’s rely on personal responsibility, help people buy their own private insurance, get our citizens insured, not with a government takeover, not with new taxes needed, but instead with a free-market based system that gets all of our citizens in the system. No more free rides. It works.

A 2007 Romney mailer said “The Romney Plan” would “Stop the Free Riders and enforce “personal responsibility.” His official platform described his national health care plan in the same terms (“Stop the Free Riders.”)

As the campaign developed, Romney began to more heavily emphasize federalism as a conservative selling point. He would not, he insisted, try to make every state copy Massachusetts in every detail. He continued to praise his state’s plan, but promised that other states need not follow it. In this sense he adopted essentially the same kind of argument he had made about abortion in his 1994 Senate race in Massachusetts – he had strong personal beliefs, but would not impose them on others.

But exactly what he was proposing was hard to discern. During a 2008 primary debate, the moderator, Charlie Gibson, asked him, “You’ve backed away from mandates at a national level.” “No, no,” he replied, “I like mandates.” Romney proceeded to defend the individual mandate as a conservative principle.

Later in the debate, Gibson circled back to confirm that Romney was indeed endorsing national mandates. Romney answered, “I would not mandate at the federal level that every state do what we do, but what I would say at the federal level is we’ll keep giving you these special payments we make if you adopt plans that get everybody insured.”

This, by accident or design, did not actually reply to the question. Romney answered a question about whether the government should create a mandate for individuals (to purchase health insurance) by denying that he would create a mandate for states (to follow the Massachusetts plan.) The question of whether Romney’s plan would make everybody pay for health insurance was left hanging.

After Obama took office, Romney began edging even closer to the view that Republicans should advocate an alternative to the Democratic health care plan. He repeatedly focused the point of contrast on the “public option,” which Obama and the Democrats wanted to include. The central theme of Romney’s health care message during this period was that the public plan was socialism and his party needed an alternative that relied totally on private insurance.

At the 2009 Conservative Political Action Conference, he told the crowd, “we need to advance a conservative plan, one based on free choice, personal responsibility, and private medicine.” That, of course, is a fair description both of Romneycare and what became Obamacare after the public option was stripped out. In a 2009 USA Today op-ed, Romney urged Obama to follow the example of his Massachusetts plan:

There’s a better way. And the lessons we learned in Massachusetts could help Washington find it.

Our citizens purchase private, free-market medical insurance. There is no “public option.” With more than 1,300 health insurance companies, a federal government insurance company isn’t necessary. 

Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.

(Kessler dismisses this op-ed because, he writes, it “appears to have been written mainly to push Obama to take a bipartisan approach to health care.” But obviously it advocated not just a bipartisan means but also particular ends – Romney’s Massachusetts plan as a substantive model for Obama to follow.)

In a 2009 appearance on NBC’s Meet the Press, he touted a bipartisan Senate health care plan called Wyden-Bennett:

We have a health care plan. You look at Wyden-Bennett. That’s a health care plan that a number of Republicans think is a very good health care plan — one that we support. Take a look at that one.

… the right way to proceed is to reform health care. That we can do as we did it in Massachusetts, as Wyden-Bennett is proposing doing it at the national level.

Romney did not directly endorse Wyden-Bennett, but he came as close as possible without doing so. What he said was utterly incompatible with his current position that an individual mandate imposed from the federal level is undesirable and even unconstitutional.

The Affordable Care Act wound up jettisoning the public option, and Romney has retreated to a much harder line, which in turn involves revising his past. Just how he has pulled this off is something of a miracle. One enormous asset, as Noam Scheiber reports, is that several of his Republican rivals this time around decided not to unleash a frontal assault on Romney. Tim Pawlenty, Rick Perry, and Jon Huntsman’s campaign all possessed opposition research on Romney’s health care position, which they thought would make him radioactive. But they didn’t want to introduce themselves to the voters by launching harsh attacks. They wanted to establish themselves as popular alternatives, force a one-on-one race, and then go after Romney. But they all had to quit. The three remaining candidates include Ron Paul, who’s functionally allied with Romney, and Newt Gingrich and Rick Santorum, both running seat-of-the-pants campaigns.

Almost all the opposition research on Romney’s health care past has come from the media itself. Yet he has generally managed to squirm out of any serious damage. His interview with Megyn Kelly on Fox News yesterday offers a handy example of his evasive tactics. Kelly begins by showing the 2008 clip of Romney at a debate telling Gibson that he supported a national mandate.

Romney’s answer? He asserts that the issue has been raised “more than a hundred times,” and that he is willing to let states have an individual mandate. But, Kelly noted, this didn’t explain why he explicitly endorsed a national mandate. “Time and again,” Romney answered, “I have pointed out that I’m not in favor of a health care plan that includes a national mandate.”

All these evasions cleverly managed to imply something without quite stating it. Has the question been raised many times? Yes — Romney has just never been forced to answer it. Did he favor letting states impose national mandates? Yes – but that’s not all he favored. Has Romney said he opposes a national mandate many times? Of course – since 2009, anyway.

But has Romney always opposed a national individual mandate? Absolutely not.

Romney’s Health Care Evasions: A History