WASHINGTON -- Nearly half a year into his second run for the White House, former Massachusetts Governor Mitt Romney has yet to clear his primary electoral hurdle. His support for health care reform legislation in Massachusetts that included an individual mandate remains a sticking point for Republican voters.
Two weeks ago, a collaborator in that effort scoffed at the idea that it had not served as the inspiration for President Obama's own health care legislation. “They're the same fucking bill,” declared MIT health care economist Jonathan Gruber. During a sit-down interview with Fox News' Brett Baier on Tuesday, Romney denied once again that he had ever envisioned his plan to be adopted federally.
These questions persist largely because Romney -- unlike a fellow mandate-backer, Newt Gingrich -- is unapologetic about the policy. He just insists that it should fall under the purview of the states.
But that wasn't always the impression he gave. Take, for instance, a speech that Romney delivered before the United States Chamber of Commerce on April 25, 2006.
That speech, which was unearthed as part of an extensive review of Romney appearances, speeches and addresses recorded in the CSPAN video archive, certainly had a different tone to it than recent statements Romney has made on the trail. The individual mandate he cheered in 2006 as "American" had become, by 2011, unconstitutional.
The Romney campaign did not return a request for comment for this article. But as is generally the case in discussions of the politics of health care policy, there is nuance. For example, earlier in that 2006 Chamber speech, he insisted that the plan he had pursued in Massachusetts "was not designed for 50 states. It was designed for one state."
"It's obvious in some respects that if we can do it there it can be done in other states and I believe that is true," he added. "I'm not sure it will be done in exactly the same way ... but the dialogue has begun."
And yet, while Romney -- both then and now -- may not have been willing to apply Massachusetts' health care plan to the country at large, he has hinted that the mandate, or some form of it, could have a national role.
On December 7, 2005, the then-governor spoke at the Manchester Republican Committee's Annual Holiday Celebration at the Wayfarer Inn in Bedford, New Hampshire. Addressing the plan he had introduced to his state legislature, he talked about requiring individuals to purchase coverage so that "people who are already paying for health insurance don't have to carry the burden of people who aren't in the system."
"That is the kind of idea that Republicans can bring," he concluded.
On July 18, 2004, Romney participated in a National Governors Association Annual Meeting event titled "Americans Without Health Insurance." In it, he lobbed questions and comments back and forth with a policy representative from Blue Cross & Blue Shield.
We have a system that, as I understand it, says: 'Look, we will pay.' And the incentives are such that I think you are going to see a growing number of uninsured who just say, 'Gosh this is an IQ test. Why should I spend more and more and more money each year when I can get this covered for free if I don't?' Am I missing something? What are the consequences of a 28-year-old saying, I'm not going to get insurance?
Waiting for the Blue Cross representative's answer, he jumped in: "So one is, they should be paying something. Yeah."
Here too, there is wiggle room. The government could require individuals to "pay something" without mandating that they purchase insurance. For example, they could be required to post a bond that could be used should they need coverage. Another alternative would be to level financial penalties on uninsured individuals after they used medical facilities. But while Romney still considers so-called free-riders a major problem with the health care industry, he has declined to endorse any of those alternatives to the mandate.
Instead, his current plan, as outlined on his campaign website, is to repeal Obama's bill, further deregulate the market (to allow for more portability of plans), pursue medical malpractice reform, and apply tax incentives to encourage coverage. The issue of universal coverage, which was the primary focus of Romney's during his governorship, is left to the states.