Romney tiptoes a fine line on health care

Voters distinguish Massachusetts law from Obama’s, survey finds

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Mitt Romney’s opponents say his Massachusetts health care law is so similar to President Obama’s that he’ll be unable to draw distinctions as the GOP’s presidential candidate, but a new poll out last week finds that voters don’t see the two laws the same.

The results of the Kaiser Family Foundation survey bode well for Mr. Romney, a former Massachusetts governor, who has walked a fine line as he tried to defend his own legislation while painting the president’s as destructive.

Of Republicans who were familiar with the Massachusetts and national laws, 62 percent said they see Mr. Obama’s law as different from Mr. Romney’s law, while 38 percent said the two laws were similar. The results were comparable among Democratic voters, with 57 percent calling the two laws different and 43 percent saying they are similar.

About one-fourth of those asked said they didn’t know enough to respond.

The issue has dominated much of the GOP’s nomination battle, popping up again in a Newt Gingrich interview on “Fox News Sunday,” with the former House speaker saying the “the gap between Romneycare and Obamacare is that big,” holding two fingers about a centimeter apart.

At Thursday’s debate in Jacksonville, Fla., former Sen. Rick Santorum of Pennsylvania pelted Mr. Romney with comparisons between the Massachusetts law and the national law.

“Governor Romney was the author of Romneycare, which … has 15 different items directly in common with Obamacare,” Mr. Santorum said.

“Think about what that means, going up against Barack Obama … you’re going to claim [that] top-down government-run medicine on the federal level doesn’t work, and we should repeal it,” Mr. Santorum told Mr. Romney. “And he’s going to say, ‘Wait a minute, governor. You just said that top-down, government-run medicine in Massachusetts works well.’ “

In response, Mr. Romney repeated his standard defense; namely, that while his law was the right solution for Massachusetts, states should be allowed to deal with health care as they see fit.

Health care experts who helped write the Massachusetts reform agree that the law largely succeeded in what it was intended to do: extend coverage to most residents. According to a Health Affairs study released last week, the uninsured rate has dropped from around 14 percent before the law was passed to around 6 percent and has remained there since 2009.

While it does require individuals to purchase coverage and offers subsidies for lower-income earners through an exchange, the law didn’t include many of the federal Affordable Care Act’s cost-control measures, such as limiting how much insurers can spend on overhead and making large rate increases subject to review.

Given the similarities — and the differences — experts remain divided on whether and how much it will hurt Mr. Romney politically.

Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology and a key architect of the state law, said successful reports coming from Massachusetts spells bad news for his campaign.

“Right now, Romney’s problem is that the law succeeded, and that’s a problem for him,” Mr. Gruber told The Washington Times. “He’s trying to argue that somehow it won’t succeed nationally. The truth is, it’s bad news for Romney.”

But Amy Lischko, who served as Mr. Romney’s health care policy director, said that’s a stretch. There is plenty of room to draw distinctions between the two laws, she said — and she thinks Mr. Romney is doing a fairly good job of drawing them.

“He doesn’t get a chance in the debates to say too much,” she said. “I think he’s right on with what he says, for the most part. The law has worked well, and I think most of the charges against the law are not true. The right is so opposed to the national law, that they can’t even say anything positive about the Massachusetts law.”

Just four years ago, Mr. Romney’s health care law didn’t give him so much to worry about, with leading Republicans applauding it. Sen. Jim DeMint, South Carolina Republican, who endorsed Mr. Romney in the 2008 primaries, said he should pass a similar law for the whole country.

But when Republicans and Democrats began negotiating over health care reform in 2009, things changed, and provisions such as the individual mandate were no longer accepted in Mr. Romney’s party, said John McDonough, director of the Center for Public Health Leadership at Harvard University

“It was the summer of 2009 as the debate heated up that the ground shifted significantly,” Mr. McDonough said. “Romney was unable to do that because his signature was on the left. So I think to some extent, he’s done the best he could in attempting to be consistent in an environment where everyone around him was running for cover.”

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