Romney's Hillary health care problem

SUMMARY: Mitt Romney has tried fiercely to distance himself in the health care debate from the views of Sen. Hillary Clinton, but as he does that he drifts from a signature victory, the health plan he enacted in Massachusetts.

There's been no harsher critic of Clinton's current health care proposal than Republican presidential candidate Mitt Romney.

As the only White House contender with a health care overhaul on his resume, the former Massachusetts governor was among the first to pronounce "HillaryCare" a form of "socialized medicine" akin to the failed program Clinton advocated more than a decade ago as first lady.

"HillaryCare is government gets in and tells people what to do from the federal government standpoint," Romney said during a debate in Michigan on Oct. 9, 2007.

But Romney's attacks on the Clinton plan have not insulated him from a persisting accusation by his GOP rivals that the 2006 overhaul he undertook in Massachusetts looks an awful lot like what Clinton is proposing as a candidate for president.

In response to his Republican opponents, Romney has been forced to draw distinctions between the Massachusetts overhaul and what he calls HillaryCare. What's more, he's also having to explain why he thinks the Massachusetts program won't work nationwide; his proposal as a presidential candidate is more incentive-based and doesn't include a requirement that everyone find coverage.

Health care remains one of the top domestic issues in this presidential election, as the number of uninsured Americans rose to a record 47-million in 2006, according to recent U.S. census data. Rising health care costs continue to pinch pockets. About half of those in a study of 1,771 people who declared bankruptcy in 2001 did so because they couldn't pay their medical bills, according to a 2005 Harvard bankruptcy study.

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Romney's Massachusetts reform and Clinton's current proposal for the nation have a lot in common, health experts say. Both expand upon the current private-public system. Neither forces changes for those who like their current employer-provided insurance. Both aim to provide coverage for all, with subsidized private plans. And both mandate coverage by penalizing those who can afford to buy a plan but don't.

"There's an awful lot of similarities between what was signed in Massachusetts and the Clinton plan, which has people here sort of surprised," said Robert Blendon, a Harvard University professor of health policy and political analysis. "He was the first to go after plans that have a similar framework to what he signed in Massachusetts, which people here consider this incredible achievement and he gets a lot of credit for."

In fact, some in Clinton's campaign have praised Romney's plan.

"Gov. Romney's plan that he introduced as a governor in Massachusetts has some important principles that could work as a framework," said Laurie Rubiner, a Clinton campaign volunteer who works on policy issues in Clinton's Senate office.

Of course, it's no secret that Clinton has proposed a health care overhaul before. Back in the early 1990s as first lady, Clinton took the lead in an effort by her husband's administration to rein in costs and expand coverage. The result, detailed in a 1,700-page proposal that scared people for its breadth and heft, went nowhere and often is cited as one of biggest failure's of the Bill Clinton presidency.

By contrast, Sen. Clinton's current health care proposal is less than a dozen pages. The idea was to offer guidelines, not marching orders, so the lack of details is "not a dodge, that was purposeful," Rubiner said.

The hallmark of Clinton's new plan is mandated coverage for all, same as in Massachusetts, although the Clinton campaign doesn't spell out how it would enforce the mandate. In Massachusetts, those who can afford to buy health care coverage but choose not to, face increasing tax penalties as the years go on.

The Clinton and the Massachusetts plans rely heavily on private-public partnerships to create pools of cheaper insurance that individuals can buy on their own.

Both Clinton's plan and the new Massachusetts law force employers who don't offer private insurance to pay into these private-public pools. When he was governor, Romney vetoed a provision to charge employers who don't pay health insurance for employees. The Massachusetts Legislature voted to override his veto.

Still, there are differences between the Clinton proposal and the Massachusetts plan. Her plan offers a "public option" for those unable to arrange coverage for themselves any other way. It would be government-run, similar to Medicare, and that's the part Romney and his supporters criticize as expanding government.

Clinton's plan also includes a requirement that those who make more than $250,000 a year, who generally have better-than-average private insurance, pay taxes on the part of their salary that goes toward their plan. Right now, all contributions to employer-sponsored health plans are tax deductible.

"She believes very strongly there's no reason that these gold-plated insurance plans for the wealthy should be subsidized by low-income people and people who don't have health insurance," Rubiner said. Another point of distinction from Romney is that Clinton proposes paying for some of her plan by getting rid of an income tax cut for those making $250,000 or more.

Some of the cost of the Massachusetts plan is covered with federal money that once went to reimburse hospitals for treating uninsured patients.

Getting the federal government to agree to let its money be used in different ways was such a feat at the time — Romney worked closely with Democratic Sen. Ted Kennedy — that flexibility in federal spending is the signature element of Romney's current health care proposal.

But Romney and his presidential campaign say the needs of individual states are too different for a single approach, even the one that's drawn praise in Massachusetts.

"The reality is you're really comparing apples and oranges when you're comparing a state health reform plan to a national health reform plan," said Lanhee Chen, Romney's domestic policy director.

In fact, the Romney campaign is eager to point out that his national plan is very different from the state plan: It lacks mandates, relies on tax incentives to encourage participation and refrains from expanding public health care programs.

His nationwide plan, which like Clinton's is short on details, seeks to make it easier for states to access federal funding to come up with their own solutions. Romney says the face of the uninsured population differs from state to state, depending on living standards and demographics.

"My plan for the country is to let every state create their own plan, hopefully a bit like ours, maybe they can come up with something better," Romney said at a campaign stop in St. Petersburg in November.

His plan would allow states to tap federal dollars to help purchase private health insurance for the low-income uninsured. Also, his plan would encourage states to aggressively enroll those who may already qualify for Medicaid but for whatever reason aren't in the program.

While Romney says he wants everyone to have access to health insurance, his plan steers clear of the word mandate, because Romney believes that "individual mandates don't work in every state," said Chen, his policy adviser.

Romney's plan for the middle-income uninsured focuses on changing tax codes so the same tax incentives that now apply for employer-provided health insurance would also be available for those who buy insurance in the individual market, Chen said. This would be done through tax breaks and expanding health savings accounts.

His plan would also put federal caps on medical malpractice lawsuits and give states federal incentives to find ways to cap Medicaid spending.