View from Washington – Matters of the States

Although he suspended his campaign, will Mitt Romney’s healthcare proposals resonate with future GOP strategy?

Last issue we examined the health reform proposal of a Democratic presidential candidate, Hillary Clinton. In this issue we will examine former Republican presidential candidate Mitt Romney’s healthcare proposal he set forth in his campaign, and what implications it may have for the Republican party this election cycle. Romney has displayed aptitude in healthcare policy, as evidenced by the major contributions he made to healthcare reforms in Massachusetts as governor. He served as the architect of a crucial overhaul known as the Massachusetts Plan, which received national coverage and now serves as the blueprint for an increasing number of state healthcare reforms. Just as important, the Massachusetts Plan has implications for the healthcare reform proposals of other Republican presidential candidates.

State responsibility
The Massachusetts health reform law was signed on April 12, 2006. Under the package that Romney crafted, the law requires all Massachusetts residents to purchase health insurance or face substantial penalties through additional income tax assessments. Those who cannot afford coverage will receive aid from the means-tested state subsidies that this initiative also established. People that fall below the income threshold or lack adequate employer-provided insurance will get coverage from funds previously designated to compensate for healthcare costs of the uninsured. Romney has highlighted on the campaign trail that his plan for healthcare utilizes federal incentives and subsidies to help states design their own systems. He hopes that by urging states to deregulate their insurance markets, and encouraging competition, those states can achieve lower premiums.

Expansion of health coverage to cover all citizens is one point that this plan has re-infused into the vocabulary of state officials when they discuss legislative plans. But this policy for the Bay State was also interpreted by some as a bold move toward universal coverage. Plans for national health coverage have been attempted since the end of World War II, and all have failed. Romney is quick to point out that his plan is not a move in the direction of national universal coverage run by the federal government. As Romney claims, his plan instead focuses on “personal responsibility” as opposed to establishing a mandate.

Some sources are wary of the similarities say exist between Romney’s plan and the proposals coming from many of his former opponents in the presidential race. Although he has criticized her healthcare proposals, there are still similarities to highlight between Romney’s plan and that of Hillary Clinton. The Massachusetts law that Romney molded and signed into effect shares a guiding principle with Clinton’s plan to build on the existing employer-based private healthcare system. Romney continually reiterates that healthcare should remain the responsibility of the states to manage and provide, and blasts Clinton’s plan as too close to socialized medicine and government insurance.

Even with what these two plans may share, there are many striking differences that pit them against each other from opposing sides of the aisle. Both Romney’s and Clinton’s platforms offer subsidies for those who cannot afford to buy private insurance themselves. The plans differ in deciding from where that money will come. Clinton’s plan uses taxes to pay for the changes, where Romney’s Massachusetts law did not rely on increasing state taxes, but rather, redirected federal dollars, fees on hospitals, and other money that already existed to subsidize healthcare for the uninsured.

Although Romney won’t be the Republican nominee, elements of the Massachusetts Plan will likely impact the message shaped by current front-runner John McCain, or whoever carries the standard for the GOP.

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit