(CNSNews.com) – Republican presidential hopeful Mitt Romney’s biggest challenge in the GOP primary might be explaining the differences between Romneycare and Obamacare--how the health care plan he signed as governor of Massachusetts in 2006 differs from the federal health care reform enacted last year.
Beyond differences the two plans may have, the linchpin of both is considered the individual mandate: the requirement that individuals buy health insurance or pay a penalty.
Twenty-seven states have sued to have this mandate in Obamacare ruled unconstitutional on a federal level, arguing that the Constitution does not give the federal government the power to force people to buy health insurance. Two federal courts have agreed, declaring the mandate unconstitutional. Additionally, some conservatives have argued that it is an unwarranted intrusion on personal liberty to empower a government to tell people that they must buy a good or service.
But Romney, as recently as 13 months ago, has staunchly defended the mandate in the law that he signed in 2006, arguing that it forces people to take responsibility for their own health care.
“Let me tell you, there’s a big difference between what we did and what President Obama is doing,” Romney said in a Mar. 7, 2010 Fox News Sunday interview.
“What we did, I think, is the ultimate conservative plan. We said people have to take responsibility for getting insurance, if they can afford it, or paying their own way. No more free- riders. And we solved this at the state level – not a federal plan, but a state plan.”
Romney went on to describe the mandate as the “biggest pro” of his health care plan.
“It’s a plan that has pros and cons,” he said. “The biggest pro, in my view, is that we don’t have free riders now expecting other people to pay for their health care costs. And we’re also able to have individuals, who otherwise would not have the kind of specialty care they need, receiving treatment.”
Two weeks later Romney said during an interview on CNN’s Larry King Live, “right now in this country, people that don’t have health insurance go to the hospital if they get a serious illness, and they get treated for free by government. My plan says no, they can’t do that. No more free riders. People have to take personal responsibility. I consider it a conservative plan.”
A spokesperson with the Romney for President exploratory committee did not respond to an inquiry from CNSNews.com about the matter.
Romney also defended the Massachusetts law during the 2008 Republican presidential primary, specifically during a New Hampshire debate on Jan. 6, 2008:
Debate moderator Charles Gibson of ABC News: “But Gov. Romney’s system has mandates in Massachusetts, although you backed away from mandates on a national basis.”
Romney: “No, no, I like mandates. The mandates work.”
GOP contender Fred Thompson: “I beg your pardon? I didn't know you were going to admit that. You like mandates.”
Romney: “Oh, absolutely. Let me tell you what kind of mandates I like, Fred, which is this. If it weren’t –“
Thompson: “The ones you come up with. Bingo”
Romney: “Here’s my view: If somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way. And that’s an American principle. That’s a principle of personal responsibility. So, I said this: If you can afford to buy insurance, then buy it. You don’t have to, if you don’t want to buy it, but then you got to put enough money aside that you can pay your own way, because what we’re not going to do is say, as we saw more and more people ...”
In a follow up question, Gibson asked Romney about his imposition of tax penalties in Massachusetts.
Romney responded, “Yes, we said, look, if people can afford to buy it, either buy the insurance or pay your own way; don’t be free-riders and pass on the cost to your health care to everybody else.”
The Massachusetts plan made Romney a prominent figure on the national stage as the first governor to enact universal health care.
In an April 6, 2006 appearance on ABC’s Good Morning America, Gibson asked him, “As I understand, the plan is that every individual has to buy health insurance if their company doesn’t provide it, and if they’re too poor the state will give it to them or will help them buy it, correct?”
Romney said Gibson’s summary was a “fair statement.”
“What we’ve found is that if you have people who sit outside the system and instead just show up at the hospital when they’re sick and expect someone else to pay, that’s a free-rider system,” Romney said.
“It’s bad healthcare for them, it’s expensive for everyone else. Now we’re saying, everybody, come on in. We want you to buy insurance if you can afford it, and we also will help you buy insurance if you can’t afford it. We look at your income, and of course, we subsidize those at very low income.”
In a frequently cited April 11, 2006 op-ed in The Wall Street Journal, Romney wrote, “Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.”The non-partisan FactCheck.org has explained some of the similarities and differences between the Massachusetts and national laws.
“Both laws have an individual mandate, requiring persons to have insurance or pay a penalty; subsidies for low-income persons; an expansion of Medicaid; an exchange where individuals can buy insurance; and requirements for employers,” it says.
The site goes on to say, “Massachusetts has a lower coverage requirement for employers, putting just a $295 per employee ‘fair share assessment’ on businesses that don’t provide insurance.” It goes on to say, “The national law, meanwhile, has a fine of $2,000 per employee for companies that don’t offer coverage, have more than 50 workers and have at least one who receives a premium credit. (The first 30 workers are excluded.)”
What does the Constitution say?
There is no constitutional question as to whether states have the authority to impose a mandate, according to Robert Moffit, a senior fellow with the Center for Policy Innovation at the Heritage Foundation, a conservative think tank.
“What the administration is saying is the interstate commerce clause gives Congress the power to impose an individual mandate. I think clearly that is false,” Moffit, who helped develop parts of the Massachusetts system, told CNSNews.com.
“If you are going to engage in commerce, you’ve got to engage in an activity. It’s one thing to engage in an activity. It is another thing for Congress to force people to engage in an activity.”
“The Constitution is also clear on another point,” Moffit continued. “That is the 10th Amendment of the Constitution. Under Madison’s interpretation of the authority of the Congress under the Constitution, any power that is not defined and given specifically to the Congress under Article 1 Section 8 is left to the states and the people.
“So states can in fact impose all kinds of mandates and they do – 48 or 49 states today impose auto insurance mandates. They could, if they wish, impose a mandate to buy health insurance as they did in Massachusetts. So there’s no constitutional question in regards to a state’s ability to impose an individual mandate for health insurance. You might think it’s bad policy. But it’s not a constitutional question.”
Moffit added that Massachusetts was dealing with a massive budget deficit caused largely by state health care spending, an issue that the health reform law was meant to address.
He said Romney initially pushed a “personal responsibility” provision that was not an individual mandate. But the Massachusetts legislature struck that from the proposal, opting instead for an individual and employer mandate.
“Romney never offered in the legislation that he introduced in July of 2005, he never introduced an individual mandate,” Moffit explained.
“What he introduced was, saying in effect, was that if people choose not to have health insurance, they would have to nevertheless accept responsibility for paying their medical bills. How do you do that? He would say if you decided you did not want to buy health insurance, you would have to have the money to pay those bills. So the proposal required them to post a bond or deposit $10,000 in an interest bearing account. So, if you ended up in an expensive hospital like Massachusetts General, at least you would be able to pay for one night’s care.”
Romney vetoed the employer mandate, but that was overridden by the legislature. He did not, however, veto the provision for an individual mandate.