Mitt Romney on Health Care Former Republican Governor (MA)

Sub-sections under Health Care:
• Mass Health Plan
• Other issues under Health Care

ObamaCare waivers on Day One; repeal bill on Day Two

ROMNEY: Rick, you're absolutely right. On day one, granting a waiver to all 50 states doesn't stop in its tracks entirely ObamaCare. That's why I also say we have to repeal ObamaCare, and I will do that on day two with a reconciliation bill, because, as you know, it was passed by reconciliation, 51 votes. We can get rid of it with 51 votes. We have to get rid of ObamaCare and return to the states the responsibility [for healthcare]. We all agree about repeal and replace. I put together a plan that says what I'm going to replace it with: to solve the problem of health care, to get it to work like a market.

RomneyCare intended as state plan; never as national model

ROMNEY: I actually wrote my book, and in my book I said no such thing. When I put my health care plan together, a Washington Post reporter asked, "Is this is a plan that if you were president you would put on the whole nation, have a whole nation adopt it?" I said, "Absolutely not. This is a state plan for a state, it is not a national plan." And it's fine for to you retreat from your own words in your own book [on Social Security's constitutionality], but please don't try and make me retreat from the words that I wrote in my book. I stand by what I wrote. I believe in what I did. And I believe that the people of this country can read my book and see exactly what it is.

In MA, we addressed only the 8% who were uninsured

ROMNEY: I don't think he knows what he was talking about in that regard. Let me tell you this about our system in Massachusetts: 92% of our people were insured before we put our plan in place. Nothing's changed for them. The system is the same. They have private market-based insurance. We had 8% of our people that weren't insured. And so what we did is we said let's find a way to get them insurance, again, market-based private insurance. We didn't come up with some new government insurance plan. Our plan in Massachusetts has some good parts, some bad parts, some things I'd change, some things I like about it. It's different than Obamacare. Obamacare intends to put someone between you and your physician. It must be repealed. That law is bad; it's unconstitutional; it shall not stand.

Reform Medicare, but don't cancel prescription program

PERRY: No. But it's a $17 trillion hole that we have in our budget we've got to deal with.

Q: [to Romney] How about you?

ROMNEY: I wouldn't repeal it. I'd reform Medicare and reform Medicaid and reform Social Security to get them on a sustainable basis, not for current retirees, but for those in their 20s and 30s and early 50s.

I stand by what I did in Massachusetts

ROMNEY: Absolutely. I'm not running for governor. I'm running for president. And if I'm president, on day one I'll direct the secretary of Health and Human Services to grant a waiver from Obamacare to all 50 states. It's a problem that's bad law, it's not constitutional. I'll get rid of it.

Q: [to Perry]: Can a state like Massachusetts go ahead and pass health care reform, including mandates? Is that a good idea, if Massachusetts wants to do it?

PERRY: Well, that's what Gov. Romney wanted to do, so that's fine. But the fact of the matter is, that was the plan that President Obama has said himself was the model for Obamacare. I don't think it was right for Massachusetts when you look at what it's costing the people of Massachusetts today.

ROMNEY: If you think what we did in Massachusetts and what Pres. Obama did are the same, boy, take a closer look: he raised taxes $500 billion; we didn't raise taxes.

Health Savings Accounts give patients stake in health costs

CAIN: First, repeal Obamacare in its entirety. Secondly, [market reforms]: deductibility of health insurance premiums; loser-pay laws; and association health plans.

ROMNEY: Herman Cain is right, and let's get back to getting the cost of health care down. The reason health care is so expensive is not just because of insurance, it's because of the cost of providing care. And one reason for that is the person who receives care in America generally doesn't care how much it costs, because once they've paid their deductible, it's free. And the provider, the more they do, the more they get paid. And so what we have to do is make sure that individuals have a concern and care about how much something costs. And for that to happen, health savings accounts. Give people a stake in what the cost of insurance is going to be, what the cost of it is going to be. Co-insurance, where people pay a share of the bill, that makes a difference.

ObamaCare has enormous differences from RomneyCare

ROMNEY: First, I'd be careful about trusting what President Obama says as to what the source was of his plan, number one. But number two, if you think wha we did in Massachusetts and what President Obama did are the same, boy, take a closer look, because:

• Number one, he raised taxes $500 billion, and helped slow down the U.S. economy by doing it. We didn't raise taxes.
• He cut Medicare by $500 billion. This is a Democrat president. The liberal, so to speak, cut Medicare. Not Republicans, the Democrat.
• We dealt with the people in our state that were uninsured, some nine percent. His bill deals with 100 percent of the people.
• He puts in place a panel that ultimately is going to tell people what kind of care they're going to have. We didn't do anything like that.
• What the president did was simply wrong. It is the wrong course for America. It is not what we did in Massachusetts.

On Day One, ObamaCare waivers to all 50 states

ROMNEY: One thing I'd do on day one if I'm elected president is direct my secretary of health and human services to put out an executive order granting a waiver from Obamacare to all 50 states. It is bad law, it will not work, and I'll get that done on day one. Now, what we faced in our state is different than what other states face. In our state, our plan covered 8% of the people, the uninsured. One thing I know, and that is that what Pres. Obama put in place is not going to work. It's massively expensive. His plan is taking over 100% of the people, and the American people don't like it and should vote it down.

ObamaCare's biggest difference: I believe in 10th Amendment

PAWLENTY: Obamacare was patterned after Mitt's plan. And for Mitt or anyone else to say that there aren't substantial similarities or they're not essentially the same plan, it just isn't credible.

ROMNEY: There are some similarities between what we did in Massachusetts and what President Obama did, but there are some big differences. And one is, I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people. We put together a plan that was right for Massachusetts. The president took the power of the people & the states away from them and put in place a one-size-fits-all plan. It's bad law. It's bad constitutional law. It's bad medicine. And if I'm president, on my first day, I'll direct the secretary of HHS to grant a waiver from Obamacare to all 50 states

MA Constitution allows mandate; US Constitution does not

A: You're asking me, what do we think we should do about Obamacare? And the answer is, I think you have to repeal Obamacare, and I will, and I'll put in place a plan that allows states to craft their own programs to make those programs work.

Q: I'm asking you where you find that authority in the Constitution.

A: Are you familiar with the Massachusetts constitution? I am. And the Massachusetts constitution allows states, for instance, to say that our kids have to go to school. It has that power. We said, look, we're finding people that can afford health insurance, that are going to the hospital and getting the state to pay for them--people who are free riders. We said, you know what? We're going to insist that those people who can afford to pay for themselves do so. That was our conclusion

If people of MA don't like RomneyCare, they can change it

ROMNEY: If I'm elected president, I will repeal Obamacare. And also, on my first day in office, I will grant a waiver to all 50 states from Obamacare. Now, there's some similarities and there are some big differences. Obamacare spends a trillion dollars. If it were perfect--and it's not perfect, it's terrible--we can't afford more federal spending. Secondly, it raises $500 billion in taxes. We didn't raise taxes in Massachusetts. Third, Obamacare takes $500 billion out of Medicare and funds Obamacare. We, of course, didn't do that. And, finally, ours was a state plan, a state solution, and if people don't like it in our state, they can change it. That's the nature of why states are the right place for this type of responsibility. And that's why I introduced a plan to repeal Obamacare and replace it with a state-centric program.

ObamaCare's power grab won't work; Obama didn't ask me

PAWLENTY: I cited Obama's own words that he looked to Massachusetts as a blueprint or a guide when he designed Obamacare.

Q: You chose those words, "Obamneycare," on "Fox News Sunday;" why is it not "Obamneycare" with Romney right here?

PAWLENTY: Using the term "Obamneycare" was a reflection of the president's comments that he designed Obamacare on the Massachusetts health care plan.

ROMNEY: My guess is the president is going to eat those words and wish he hadn't put them out there. And I can't wait to debate him & say, Mr. President, if, in fact, you did look at what we did in Massachusetts, why didn't you give me a call and ask what worked & what didn't? And I would have told you, Mr. President, that wha you're doing will not work. It's a huge power grab by the federal government. It's going to be massively expensive, raising taxes, cutting Medicare. It's wrong for America. And that's why there's an outpouring across the nation to say no to Obamacare.

Base health care system on free choice & private medicine

Mandating citizens to buy health insurance is conservative

Get everyone some form of catastrophic health coverage

FactCheck: Untrue that 47M uninsured want to “not play”

This idea--that most uninsured Americans simply don’t feel like having health insurance--is simply not the case: Most people who are offered insurance do not turn it down. A 2007 study found that 20% of the uninsured could have afforded coverage, but even leaving aside other factors like being turned down for insurance, that’s hardly 47 million people refusing to “play.”

Romney is also misleading when he implies that the uninsured are simply choosing between toeing the line and freeloading. While uninsured individuals can get a certain amount of free emergency care, it is by no means comparable to the care given to those with insurance.

Personal responsibility instead of employer mandates

A: Well, I actually got the job done. Working with people across the aisle, we said: Enough is enough. Look, the best kind of prevention you can have in health care is to have a doctor. And if someone doesn’t have a doctor, doesn’t have a clinic they can go to, doesn’t have health insurance to be able to provide the prescription drugs they need, you can’t be healthy. And you need to have health insurance for all of our citizens. And I found a way to do that without requiring raising taxes, without a government mandate, without a government takeover. When I said government mandate, I meant employer mandate. Instead, we have personal responsibility. We allowed individuals to buy their own policies. Those that couldn’t afford them, we helped them buy their policies. And you know what? It cost us no more money to help people buy insurance policies that they could afford than it was costing us before, handing out free care.

Let states create their own private, market-based insurance

ROMNEY: First of all, I’m not going to give the Democratic legislature credit for the plan that I helped build. I think it’s a model that other states can adopt in some respects. But our plan is different than Hillary Clinton’s in a lot of important ways. For Democrats, they want to have government take it over. The right answer is to get all of our citizens insured so they don’t have to worry about losing their insurance if they change jobs or have a preexisting condition. But Hillary says the federal government’s going to tell you what kind of insurance, and it’s all government insurance. And I say no, let the states create their own plans, and instead of government insurance, [have] private, market-based insurance. Hillary’s plan costs an extra $110 billion. My plan doesn’t cost any additional money.

Removing most mandates drove down premium cost by half

ROMNEY: We took as many mandates out as we could in our policies. And the legislature kept some there. I tried to take them all out; they put some back in. It was a compromise. They put some mandates there. But, let me tell you how many we got out. The price of the premium for an individual, 42 years old, in Boston, used to $350 a month. Now, it’s $180. We basically cut it in half by deregulating. Congressman, you’re absolutely right that taking regulation out of insurance brings the price down, and that’s why my plan would go state by state, deregulate them so we can get the cost of premiums down. We got the job done.

FactCheck: HillaryCare closer to RomneyCare than “all gov’t”

• They both require that individuals obtain insurance and also require employers provide it.
• They both provide government subsidies for those with low incomes.
• Both expand the number of people covered under Medicaid.

Same tax treatment if people buy insurance without employers

Get everybody insured with state-based market dynamics

1. We’re going to have states create their own plans. We did it in our state, and it’s working. We’re not going to have the federal government tell them how to do it.
2. We’re not going to spend more money. Hillary Clinton’s plan costs $110 billion. Mine says, let’s use the money we’re already spending a little more wisely.
3. Instead of having the federal government give you government insurance, Medicare and federal employee insurance, let’s have private insurance.

MA plan blends personal responsibility & universal coverage

Here’s a crash course in the 2006 Health Reform Statute. Every person is required to buy health insurance. Young, healthy people--who ordinarily wouldn’t buy health insurance--have to get it, even if they feel like they don’t need it. This inclusiveness lowers the premiums and allows state funds that were earmarked for medical care for the uninsured to be used to provide insurance for the populace. Medicaid still covers the indigent.

Critics say this isn’t fair to require everyone to buy health insurance. But it’s as equitable as requiring all drivers to buy automobile insurance. Everybody pays for the uninsured anyway, whether it’s in higher auto insurance premiums or higher hospital bills. Health insurance as a civic duty is a noble concept, but one that just may work.

Conservative idea: individual responsibility for health care

• On American Healthcare: “The wonders of America--like our healthcare technology--can be powerful tools to promote the foundations of liberty. It is time that we apply these American wonders to make the world, and in turn to make America, a safer, freer, and more prosperous place.”
• On Insurance for All: “We can’t have as a nation forty million people--or, in my state, half a million--saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay. It’s a conservative idea, insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.“
• When asked to compare his program with that proposed by then-First Lady Hillary Clinton: ”Perhaps the biggest between our two plans was that mine got passed and hers didn’t.“

Insure 45 million uninsured with a free-market based system

FactCheck: Romney plan virtually identical to Obama plan

There are two problems with Romney’s characterization: One, Ohio Rep. Dennis Kucinich is the only Democratic candidate to propose a single-payer, wholly government-funded health care plan. And two, Romney’s Massachusetts universal insurance system bears a striking resemblance to the health care proposals of the Democratic front-runners. For example, the Obama and Romney plans are virtually identical. But in our view, the term “government takeover” could only be applied to Rep. Kucinich’s proposal.

Pharmaceutical companies create products to make us better

And are there excesses? I’m sure there are, and we should go after excesses. But they’re an important industry to this country. But let me note something else, and that is the market will work. The buyer doesn’t have information about what the cost or quality is, or different choices they could have.

Subsidies for health coverage for low-income individuals

Voluntary purchasing pools

• Favored creating voluntary purchasing pools through which small businesses and individuals could buy insurance
• Pledged to cut health care costs through market-based reforms such as providing information on the price and quality of health care services to consumers.

2006 lessons: involve everyone; demonize none; transparency

People without insurance already receive care via E.R.

Massachusetts insurance regulations also didn't help. The commonwealth required insurers to offer only benefit-rich policies--and consequently, such policies were very expensive. Further, the state didn't allow insurers to adequately discount policy premiums for young healthy people. As a result, premiums for individuals who were not part of a pool were excessively high, & young healthy people declined to pay for them.

2006: Compromise with Ted Kennedy to make RomneyCare reality

1. Those who could afford insurance would either buy it pay their own health-care costs--no more free riders showing up at the hospital expecting to ge care at tax-payers' expense
2. For those who couldn't afford health insurance on their own, the state would pay a portion of their premium with the amount of the subsidy determined on a sliding scale by income
3. To make it easier to insurers to service individual customers, the state would create a "connector" or "exchange" that would collect premiums and pass them on to the insurers.

FactCheck: MA employers have no mandates, but “requirements”

Massachusetts may not call its rules for employers a “mandate,” but the state health care plan includes several “obligations” or “requirements,” as the state dubs them, for employers, along with fees for noncompliance. The requirements for employers are much narrower than those for individuals, who indeed, according to the state, face a “mandate” to get health insurance.

But is a “requirement” a “mandate”? You be the judge: Employers with more than 10 full-time employees must pay at least 33% of employee premium costs or have a group health plan. Those that fail to do so must pay a fee of $295 per full-time employee per year.

Individuals in the state must have health insurance. If not, they’ll lose their personal exemption on state income taxes in 2007--a penalty of $219.

FactCheck: No, MA healthcare plan is not paid for, yet

The Massachusetts Taxpayers Foundation estimated that the state would need an extra $200 million each year for 2007 to 2009 to finance the health care plan, because more people enrolled in subsidized care than anticipated. That shortfall, however, is a projection, and a Boston Globe article on the budget gap said some money could be shifted from the free care fund, if there is money in that fund to do so. Additional dollars came from a Medicaid waiver granted by the federal government, which is set to expire in 2009. The Massachusetts government is negotiating with federal officials to renew that waiver.

FactCheck: MA plan works, but Romney not proposing it for US

It’s also unclear how many of the previously uninsured have gained coverage under the Massachusetts plan. While the program has successfully enrolled 200,000 people, some of those may have switched from less desirable policies. A more apples-to-apples measure found that 395,000 people didn’t have insurance in the state in 2006, then a 10% decrease in the uninsured through July 2007.

MA program relies on personal responsibility & the market

A: As governor, I talked to people, and they say, “If I lose my job, I’m worried I’ll lose my insurance, and my insurance premiums are getting higher and higher.” And we said: We got to find a way to get everybody insured. And the last thing we want is to have the government take over health care, because anything they take over gets worse. We said: We need to find a way to get everybody in our state insured with private insurance. [We found] a way to get them insured without raising taxes, without a government takeover. It relies on personal responsibility. Every Democrat up there’s talking about a form of socialized medicine, government takeover, massive tax increase. I’m the guy who actually tackled this issue. We get all of our citizens insured. We have to stand up and say the market works. Personal responsibility works.

MA health plan insures all without taxes or socialization

A: I love it. It’s a fabulous program. I’m delighted with the fact that we worked together across the aisle, Republicans and Democrats, to find a way to get health care for all of our citizens that’s affordable and that’s portable. I helped write it and I knew it well, and this is a country that can get all of our people insured with not a government takeover, without Hillarycare, without socialized medicine. Instead, get the market to do its job. Let me people have health care that they can afford. Get the market to do its job. Let people have the opportunity to choose policies in the private sector. We didn’t expand government programs. We didn’t raise taxes. There was no government takeover.

FactCheck: MA plan not yet in place so analysis premature

Overall, it’s too soon to tell how successful the Massachusetts plan will be. The requirements for health coverage do not go int effect until July. By April, nearly 70,000 people had signed up for subsidized health plans. That number is half of those eligible. But the total estimate of uninsured Massachusetts residents is 372,000. The state has a long way to go.

And it has hit some snags in implementing the law. The initial bids from insurance companies were much more expensive than what Romney had touted, because over 200,000 insured residents would need to buy additional coverage to meet the original state requirements.

Signal accomplishment as Governor is MA insurance reform

MA reform focuses on individual responsibility (via fines)

In fact thousands of those risk-takers end up needing health care, and of the expensive sort. The state and the care providers eat the costs, which means the taxpayer and premium payers eventually get the bills. To this group, Romney gives no choice. In January, 2008, they must either insure themselves or be subject to a fine. The poor get subsidies as well as assistance in signing up.

The legislature tacked on a provision that penalizes companies of 11 or more employees that do not provide health insurance. Romney vetoed this add-on. The legislature overrode his veto. But the lawmakers still handed Romney an enormous victory. They did so because the plan manifestly makes sense.

State universal coverage plan is national test case

The program’s passage with overwhelming bipartisan support is a notable achievement. It remains to be seen how many uninsured people actually order policies. Romney remarked, “I wish I were going to be governor the next five years to see it through,” but he will step down at the end of this year and is preparing to seek the presidency. Meanwhile, his health plan gives him a unique calling card-and provides the country with an important opportunity to test one possible solution to a vexing problem.

MA state health insurance plan lowered costs

Mandates on health insurance work in Massachusetts