Of the many political conversion experiences that former Massachusetts Gov. Mitt Romney has undergone, none rival his evolving views on health care. While governor, Romney pushed for a plan that ended up being the model for the Affordable Care Act — Obamacare.
Now, while still bragging about what he did in Massachusetts, he promises to repeal and replace Obamacare with …
And that’s the problem.
“The general approach is there,” Nina Owcharenko, a policy analyst with the Heritage Foundation, a conservative policy and research organization told the Milwaukee Journal Sentinel’s Guy Boulton. “But the details — I guess we will just have to wait and see.”
“Wait and see” may be good politics in the middle of a tight election, but it isn’t good enough for voters. Romney’s policies now (if he really believes them) would not expand coverage and, in fact, might lead to fewer insured people.
Romney favors a state-by-state approach, which we think inevitably leads to inequity. Even if we bought the idea that a patchwork of programs was best, the Massachusetts experience is not that instructive.
Massachusetts drew on state money from a tax on providers, employers and insurers. The Bay State also relied on federal Medicaid money (and Romney backs a House budget that would limit future growth in Medicaid spending). And Massachusetts is a relatively affluent state with a small percentage of people without health insurance. Southern states, in particular, with their large numbers of uninsured people, would have to increase taxes, perhaps substantially, to do what Massachusetts did.
The main elements of Romney’s plan:
Health insurance plans bought by individuals would be tax deductible. We favor this, but it would not expand coverage that much because lower income people generally pay very little — or no — federal income tax.
Public-private partnerships, exchanges, subsidies to help the uninsured, high-risk pools for people who suffer from chronic conditions, coverage for people with pre-existing conditions. But there are scant details on how any of this would work.
Tort reform. By all means, let’s limit defensive medicine practiced simply to avoid a lawsuit. But most studies show it only accounts for a small fraction of total health care spending, about 2.4 percent or $55.6 billion in 2008 dollars. “As a percent of the total, it’s not going to change the system,” Robert Laszewski, a consultant and former health insurance executive, told Boulton.
Selling insurance across state lines. We’d favor the idea conceptually, but there is evidence that it may not do much to lower costs. In three states that allow the practice, the laws have been unsuccessful, a recent brief by the Center on Health Insurance Reform at Georgetown University shows.
Allowing small business to form purchasing pools, such as association health plans. There is almost no value in such ideas, experts say. “We already buy insurance in bulk,” Laszewski said. “It’s called Blue Cross. It’s called UnitedHealthcare. … When we talk about selling insurance across state lines and association health plans as solutions, insurance executives laugh out loud,” he added.
Medicaid block grants. While we favor giving states more wiggle room for experimentation in this federal-state program, there is a legitimate fear that a block grant approach means less money over time for insuring the poor, disabled and aged.
Romney had the right idea in Massachusetts, but the hard right turn taken by his party forced him to put that idea back on the shelf and pick from an old Republican wish list. What he’s left with is a bag full of stale ideas.
Obamacare is far from perfect. It expanded coverage massively without fully dealing with health care’s cost beyond theoretical arguments. Nonetheless, the best approach is to salvage the Affordable Care Act — not throw it out.