The state health reforms overseen by Mitt Romney while he was governor of Massachusetts have received significant attention throughout this campaign season. But the health policy record of the presumptive Republican presidential nominee goes beyond this state law to include a range of hot-button issues –- from the future of the federal health law to plans to revamp Medicare and Medicaid costs as well as a range of market-based initiatives –- that will continue to draw attention as the November election approaches.
See also: President Obama on health care.
KHN has assembled this resource to show in detail how these positions are taking shape.
Photo by Tim Sloan/AFP/Getty Images
- Was a key player in the effort to reform Massachusetts' health care system. Before his election as governor, he campaigned on a health overhaul plan that included the following elements: charging co-pays to higher-income Medicaid recipients to expand coverage, requiring employers of more than 10 employees to offer insurance or pay a penalty, extending favored prescription pricing in the state's drug plan for elderly and disabled residents and negotiating an increase in federal funding for Medicaid. In 2005, he proposed Commonwealth Care, which helped frame the negotiation for health care reforms that ultimately became state law.
- After his term as governor ended, he cited the 2006 state health reform law as a point of pride, but has since distanced himself from it because it is often considered a prototype for the federal Affordable Care Act, an assertion he rejects. The Massachusetts law includes the creation of an online insurance exchange known as the Health Connector, as well as fines against businesses with more than 10 employees that don't offer health insurance plans and a mandate that all individuals not covered by public health insurance purchase health insurance.
“If somebody could afford insurance, they should either buy the insurance or pay their own way. ... We said: If you can afford insurance, then either have the insurance or get a health savings account. Pay your own way, but no more free ride. That was what the mandate did.” – Romney, GOP candidate debate, Jan. 30, 2008.
- Defends Massachusetts' individual mandate because it was a state-level decision –- not a matter imposed by the federal government.
“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 and what didn't? ... I would have told you, Mr. President, that what 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.” – Romney, GOP candidate debate, June 13, 2011.
- Advanced a managed care plan for seniors who are eligible for both Medicare and Medicaid.
- Was silent on a 2005 proposal to extend health care benefits provided by the state government to same-sex couples.
- Proposed tort reform legislation in 2006 that would reduce legal fees and make a hard cap of $500,000 on non-economic damages. Lt. Gov. Kerry Healey led this effort.
“I like what I proposed in Massachusetts when I was governor. And even though the final bill and its implementation aren't exactly the way I wanted, the plan is a good model. Today, almost every Massachusetts citizen who had been uninsured now has private, free-market coverage, and we didn't have to raise taxes or borrow money to make it happen. We may find even better ideas in other states. But let's make certain that conservative principles are front and center. A big-government takeover of health care is the next thing liberals are going to try, and it's the last thing America needs” – Romney, CPAC Convention, Feb. 27, 2009.
On Medicare & Aging, Romney:
- Favors Medicare reforms that would give future beneficiaries a "defined contribution" or "premium support" and allow them to choose between private and traditional plans.
- Maintains that seniors already enrolled in Medicare, or those nearing retirement, would not be affected by his plan, which also would retain a fee-for-service option.
"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” – Romney, Tampa Tea Party Debate, Sept. 12, 2011.
- All plans would have to offer coverage at least comparable to what Medicare provides today, though premiums for "traditional" coverage would rise if private companies can provide the same services for less. Critics say that capping the government's contribution would likely mean that beneficiaries' costs would increase.
- Backed the December 2011 Medicare proposal by Rep. Paul Ryan, R-Wis., and Sen. Ron Wyden (PDF), D-Ore.
- Prior to the Ryan-Wyden plan, supported the Medicare overhaul included in the Ryan budget plan that was approved by the GOP-controlled House of Representatives.
- Supports the notion that wealthier seniors should pay more toward their health coverage and lower-income seniors should receive a higher subsidy.
- Wants to publish a yearly federal balance sheet to help people understand the impact of entitlement spending on the budget and economy.
On the Health Care Marketplace, Romney:
- Wants to strengthen high-deductible health savings accounts by allowing consumers to use them to pay insurance premiums.
- Supports caps on non-economic damage awards in medical malpractice lawsuits and funds for states to develop other ways to deal with the liability issue, such as health care courts.
- Urges restricting federal regulation of health care insurance, although he supports limited rules to bar insurers from denying coverage to those with preexisting conditions when they have had coverage for a specified period of time.
- Supports "co-insurance" plans, in which consumers pay a fixed percentage of the cost of their care.
- Says insurers should be allowed to sell their products across state lines.
- Endorses ending "tax discrimination against the individual purchase of insurance" and has suggested allowing tax deductions for people who obtain health insurance on their own; also favors allowing individuals and small businesses to join together to buy insurance.
- Wants to issue "Consumer Reports"-type ratings of insurance plans.
"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 [we need] 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." – Romney, Tampa Tea Party Debate, Sept. 12, 2011.
On Health Reform Philosophy, Romney:
- Says he would allow states to opt out of the federal health law and encourage Congress to repeal it.
- Believes that "each state should be able to fashion their own program for the specific needs of their distinct citizens," and that states are the "laboratories of democracy."
- Maintains that "market dynamics" such as increased competition, provider performance ratings, cost comparisons for procedures, co-insurance and lowering the number of uninsured will improve the health care delivery system.
- Endorses efforts to find an alternative to the fee-for-service payment model.
"I want people to be able to own their own insurance, if they wish to. And to buy it for themselves and perhaps keep it the rest of their lives and to choose among different policies offered from companies across the nation," he said. "That means the insurance company will have an incentive to keep you healthy. It also means, if you don’t like what they do, you can fire them." –- Nashua, New Hampshire, Jan. 9, 2012
On Medicaid, Romney:
- Opposes the health law's expansion of Medicaid coverage to as many as 17 million people.
- Supports Medicaid block grants to allow states to use capped federal contributions to run the program with more flexibility.
- Favors reducing the amount of money the federal government spends on Medicaid.
Also of interest: Campaign civility IS possible.
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