HEALTH CARE RomneyCare Vs. ObamaCare As former Republican Massachusetts governor Mitt Romney travels around the country promoting his new book No Apology and feeling out a potential 2012 presidential bid, he continues to struggle with questions about why he wants to repeal a new federal health care law that is so similar to the reform he signed in 2006 as governor. If he wants to promote "himself as a problem-solving pragmatist, Mr. Romney can justifiably point to the landmark universal coverage law in Massachusetts that he, as governor, proposed in 2006," the New York Times observes. "But as he appeals to conservative activists and Republican primary voters, he is trying to draw nuanced distinctions between his Massachusetts law and the federal legislation that shares many of its fundamental elements, including a requirement that people have insurance." Indeed, Romney is attempting to present himself as a pragmatist and a principled conservative who opposes federal intervention into health policy. Thus, Romney has had to embrace his plan while, at the same time, attacking President Obama's in an effort to appease the GOP and the conservative base, which adamantly oppose it.
MASSACHUSETTS REFORM: On April 12, 2006, Romney signed into law landmark legislation to provide universal health care coverage to state residents. The bipartisan law "combined the concept of individual responsibility through an individual mandate on the purchase of health insurance with government subsidies to ensure affordability." All Massachusetts residents are now required to purchase health care coverage, and employers with more than 10 employees must provide health insurance coverage or pay a "fair share" contribution of up to $295 annually per employee. (Romney vetoed this provision of the plan, but, the legislature overrode the veto.) The law established two different health insurance connectors to "connect" individuals and small businesses to affordable, quality products. Small businesses and individuals can purchase unsubsidized coverage through the Commonwealth Choice, while lower-income residents up to 300 percent of the federal poverty line can find subsidized insurance in the Commonwealth Care. The Massachusetts law also merged the nongroup/individual and small-group health insurance markets built on the regulatory protections already existing in both markets -- including guaranteed issue and renewal, medical underwriting prohibition, pre-existing condition limitations, and modified community rating. The law expanded Medicaid to children up to 300 percent of the federal poverty level and increased the enrollment caps "on existing Medicaid programs for adults." The plan pays for itself with a redistribution of existing funding, including federal Medicaid payments previously paid to safety net providers, "assessments on insurers, hospitals, and employers; and state general funds." But while Massachusetts significantly expanded coverage, the state did not develop any cost containment strategies. Even though Romney vetoed eight different sections of the bill (all of which were restored by the legislature), he described the law as "exactly what we'd hoped for" at the signing ceremony.
THE INDIVIDUAL MANDATE: Romney has repeatedly described the individual mandate as a "conservative" solution built on the principle of "personal responsibility" and has argued that it has helped insure 98 percent of all Massachusetts residents. "Everybody in America today has health care. If they get sick, even without insurance, they get free care, paid for by government. We said no more of that. No more free riders. We want people taking personal responsibility for getting health insurance if they can afford it," Romney said during a recent interview with Fox Business. "If you can afford it you have to buy insurance on your own. Half the people can afford it, bought insurance on their own. No more government subsidy for them. Others we had sliding scale based on income." During the presidential campaign in 2008, Romney reiterated his support for "mandates on a national basis," saying, "I like mandates. The mandates work." But in the beginning of this year, as Obama drew closer to signing a federal health bill that included the individual requirement, Romney began to oppose the individual mandate. In March, Center for American Progress Action Fund researcher Lee Fang pressed Romney on the constitutionality of health care reform, asking the former Massachusetts governor if he believed that the individual mandate at the center of his own health care reform effort was, in fact, unconstitutional. Romney refused to answer, telling Fang, "You know I've got a long discussion that I could give you on that, but I'm in too harp hay of a hurry right now but I think we have that on the site. ... I think I've answered that the best way I can right now which is it's a big topic and I'm happy to discuss it at length but I just can't do it in the hall going to the elevator." Earlier this month, however, Romney decided that the individual mandate was in fact unconstitutional. "I'm not enough of a judge," he said. "I think it's unconstitutional on the 10th Amendment front." Recently, Romney told a conservative blogger that he would not support repealing the provision because of the "deleterious effect it would have on those with pre-existing conditions in obtaining health insurance." He has since backtracked from these comments.
MASSACHUSETTS AS A MODEL: It's unclear if Romney sees his landmark accomplishment as a model for the nation. In 2007, Romney predicted, "If Massachusetts succeeds in implementing it, then that will be a model for the nation. If not, other states that are copying aspects of Massachusetts' [plan] will find a better way, and then we can copy them." In October 2009, Romney urged Democrats to use the Massachusetts law as a model to expand coverage. "We have found that we can get everybody insured without breaking the bank and without a public option," Romney told CNN's Sanjay Gupta. "Massachusetts is a model for getting everybody insured in a way that doesn't break the bank, doesn't put the government in the driver's seat and allows people to own their own insurance policies and not to have to worry about losing coverage. That's what Massachusetts did," he said. But when confronted with his statements in a recent Newsweek interview, Romney said that by "a model for the nation" he really meant a model for the states, not the federal government, to follow. "It is a model for the states to be able to learn from. During the campaign, I was asked if I was proposing that what I did in Massachusetts I would do for the nation. And the answer was absolutely not. Our plan is a state plan. It is a model for other states -- if you will, the nation -- it is a model for them to look at what we've accomplished and to better it or to create their own plans." It turns out that Romney never believed that the federal government should be involved in health care policy; he would only use federal dollars to encourage states to experiment with different proposals. But this kind of approach, if it's to be pursued, would lead to national inequality and disadvantage the states that need reform the most. After all, Romney was only able to pass and sign health care reform in 2006 because Massachusetts already enjoyed a relatively high insurance rate (10.7 percent uninsured in 2005, compared to 15.7 percent national average), a strong foundation of employer-sponsored insurance supported by an expansive Medicaid program, robust state regulations and a fairly liberal electorate. Other states don't have these advantages. Nationally, state uninsured rates "vary from just under 8 percent to almost 25 percent," and the states with the least resources often have the highest uninsurance rates. They would be most disadvantaged under Romney's state-based approach because they don't have the economic, political or structural capacity to invest in something as big as health care reform and their populations face more prevalent rates of obesity, diabetes and other expensive chronic conditions. Asking these states to take some federal dollars and simply expand coverage ignores the challenges at the state level, where governments have to balance their budgets every year and are facing economic challenges in funding their existing health programs.
IMMIGRATION -- ARIZONA SENATE PASSES NEW HARSH ANTI-IMMIGRANT BILL: On Monday, the Arizona Senate passed the "Support Our Law Enforcement and Safe Neighborhoods Act," (SB 1070) which, if signed into law, would be one of the most "stringent immigration laws in the country." The bill is authored by State Senator Russell Pierce (R), an anti-immigrant firebrand known for praising the controversial 1950s deportation program named "Operation Wetback." SB 1070 would grant police officers broad authority to "demand proof of legal entry into the United States from anyone suspected of being in the country illegally," and to even "conduct warrantless arrests" if an officer has probable cause to believe a deportable offense has been committed. In essence, a police officer could arrest anyone who cannot immediately prove that they are in the country legally, leading the New York Times to conclude that it "means if you are brown-skinned and leave home without a wallet, you are in trouble." The ACLU of Arizona has also predicted that the bill will "exacerbate the problem of racial profiling," which "raises concerns about the prolonged detention of citizens and legal residents." While the bill has garnered the support of state conservatives, even drawing praise from Sen. John McCain (R-AZ), who has sharply veered to the right on immigration during his primary challenge from J.D. Hayworth -- Latino Republicans have drawn a line in the sand, telling Gov. Jan Brewer (R) to veto the measure. Somos Republicans, an Arizona Latino Republican group, issued a press statement explicitly stating that "if Jan Brewer signs SB 1070 next week, members of Somos Republicans and several Arizona Hispanic Republicans will not vote for her in 2010." Brewer, who is involved in a tough primary fight catering to the far-right for the 2010 gubernatorial nomination, has been receiving "non-stop" phone calls from residents on the legislation.
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Activists from the LGBT rights group GetEQUAL interrupted a speech by President Obama at a California fundraiser yesterday. The activists were upset at the administration's lack of progress in repealing the military's Don't Ask Don't Tell policy, which is now opposed by six out of ten Americans. Goldman Sachs' earnings "rose 91 percent in the first quarter of 2010, to $3.46 billion," up from $1.81 billion in the same period last year, beating analyst expectations. The "strong results are likely to be overshadowed by the Securities and Exchange Commission's civil suit against the firm," which accuses Goldman of fraud. Britain's financial regulator is "launching a full-blown investigation into Goldman." Goldman Sachs has hired ex-White House counsel Gregory Craig to run its legal defense and public relations campaign against recent charges from the Securities and Exchange Commission (SEC). Last week, the SEC charged the megabank with fraud related to collateral debt obligations and the subprime mortgage crisis. White House chief of staff Rahm Emanuel told PBS's Charlie Rose yesterday that he would like to be the mayor of Chicago. "I hope Mayor Daley seeks reelection. I will work and support him if he seeks reelection," Emanuel said. "But if Mayor Daley doesn't, one day I would like to run for mayor of the city of Chicago. That's always been an aspiration of mine even when I was in the House of Representatives." Senate Democrats are likely to scrap a proposal to create a $50 billion resolution fund by levying a fee on big financial institutions. The fund would be used to provide for the dissolution of large systemic institutions in the event a resolution needs to occur. Republicans had falsely characterized it as a "permanent bailout fund." More than 1,500 lobbyists, financial institution executives, and bankers have "made their way to the Senate committee that…will take up legislation to rein in derivatives, the complex securities at the heart of the financial crisis, the billion-dollar bank bailouts and the fraud case filed last week against Goldman Sachs." JP Morgan Chase CEO Jamie Dimon said new regulation rules "will be negative" for Wall Street. Iraqi and U.S. Special Forces killed two top leaders of the insurgent group al-Qaeda in Iraq last weekend in Tikrit, "a decisive tactical victory for American and Iraqi forces and one that provides Prime Minister Nouri al-Maliki with additional political leverage" as the country forms a new government. The Senate voted 84-10 yesterday to "move forward on the long-delayed nomination of Lael Brainard to serve as undersecretary in the Treasury Department" for international affairs. Brainard was nominated in December and a final confirmation vote is expected today. The Department of Education "will no longer allow universities to rely solely on student surveys to prove they are meeting the requirements of the gender-equity law known as Title IX, a reversal of a Bush administration policy that had been opposed by the N.C.A.A. and women's sports advocates." In advance of today's announcement, Vice President Biden said, "Making Title IX as strong as possible is a no-brainer." And finally: How do you pronounce Eyjafjallajokull?
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CALLER: [You said that] George Bush claimed that he wasn't going to play golf anymore after 9-11 and then he never did. That is inaccurate. Yes, he did.
HANNITY: George Bush. No, no. After the war started, ... he made a decision not to play golf for the rest of his presidency and he didn't.
-- Fox News' Sean Hannity, 4/19/10
VERSUS
"Now watch this drive."
-- President Bush, 8/04/02, playing golf
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