GOP presidential candidate Mitt Romney on Friday released his principles for national healthcare reform but left out the linchpin of the plan he enacted as governor of Massachusetts: a requirement that individuals get coverage.
That shift could help him win over conservative Republican primary voters, experts said. But if he succeeds in becoming the GOP nominee, he may have to zigzag back to his Massachusetts roots to appeal to independents and Democrats.
Speaking to doctors in South Florida, Romney said he would encourage each state to seek its own solution to the problem of 45 million uninsured people in America.
The federal government would play a supporting role by offering tax breaks for individuals to purchase private insurance, granting governors more flexibility in using federal healthcare funds, overhauling the malpractice litigation system and making other changes.
“A one-size-fits-all national healthcare system is bound to fail,” Romney said. “It ignores the sharp difference between states, and it relies on Washington bureaucracy to manage.”
Some have accused Romney of running from his record in Massachusetts. On Friday, he took credit for the experiment there, a work in progress now under a Democratic administration. But he pointedly did not endorse a so-called individual mandate at the federal level.
As governor, Romney had insisted that such a requirement was the only way to guarantee coverage for all. Reform would not work if people had the option of remaining uninsured, he argued at the time. Government would help those who couldn’t afford to pay, he had said.
“He is facing a different constituency now, which is the Republican primary voter,” said former Medicare Administrator Mark McClellan, a leading GOP healthcare expert. “They are very concerned with anything that would be perceived as a major expansion in government healthcare.”
“It sounds to me like he is talking now about his own convictions, and they do seem to be more conservative,” said Grace-Marie Turner, head of the Galen Institute, which advocates market-based fixes to healthcare problems. “But you can’t help but look at the record of what he actually produced in Massachusetts.”
Although the Massachusetts plan -- enacted last year -- is closely identified with Romney on the national political stage, it came about through a painstaking process of consensus-building. Romney was a key player but not the sole author.
“This law was a genuine political amalgam,” said John McDonough, executive director of Health Care for All, a Massachusetts advocacy group that played a central role in the debate and sometimes clashed with Romney. “It is absolutely true that Mitt Romney contributed a lot to this law, and it is also true that there is a lot from other sectors and other sources.”
As governor, Romney embraced the idea of requiring individuals to obtain medical insurance as an alternative to requiring employers to do so. The latter approach contributed to the 1990s political defeat of a plan put forward by President Clinton and First Lady Hillary Rodham Clinton. (She is now seeking the Democratic presidential nomination.)
In fall 2005, the Democratic speaker of the Massachusetts House signaled that he would be open to the individual requirement. That paved the way for a deal, which included a small tax on employers that did not provide coverage.
Romney vetoed the employer charge but was overridden by the Legislature.
Romney’s latest plan is basically a compilation of standard Republican ideas. He supports tax-sheltered health savings accounts for routine medical expenses, coupled with lower-cost catastrophic insurance for major illnesses. And, like President Bush, he would let states use federal funds that now pay for hospital care for the uninsured to help citizens buy private insurance.
Most of these approaches have little support from Democrats, who control Congress. But some of the leading Democratic presidential candidates have warmed to the idea of an individual mandate: Former North Carolina Sen. John Edwards supports it, and Illinois Sen. Barack Obama would require parents to have coverage for their children.
“Obama and Edwards have both endorsed an individual mandate,” said health economist John Holahan of the nonpartisan Urban Institute, who formerly did work for a nonprofit that helped keep the Massachusetts dialogue moving. “You would think that [Romney] could bring the country together on something like this, given that it’s accepted by some of the Democratic candidates.”
The Galen Institute’s Turner, a critic of the Massachusetts plan, said Romney may yet do that.
“Romney is more tempered than other candidates [on healthcare], and he may be able to be a more sophisticated negotiator,” she said.
“In a general election, he’s going to have to go back more toward the center, I would think.”
This report includes information from the Associated Press.