Published: December 3 2007 21:56 | Last updated: December 3 2007 21:56
Before signing his landmark healthcare reforms into law last year, Mitt Romney, then governor of Massachusetts, took a moment to thank some of the people who made it possible.
Among those praised was Edward Kennedy, the state’s veteran Democratic senator, whom Mr Romney called a “collaborator and friend”. The ceremony marked the crowning achievement of Mr Romney’s time as governor, and sealed his reputation as a moderate Republican who could work with Democrats.
Many more are covered but funding is a concern
Mitt Romney’s landmark bill to provide nearly universal healthcare coverage to the residents of Massachusetts, introduced in April 2006, was touted across the US as a model for how to provide healthcare coverage without establishing a single government-controlled system.
The law requires all residents to buy health insurance or face a fine or tax penalty. Perhaps the plan’s biggest achievement is its number of new enrollees: as of November 1 of this year, more than 200,000 formerly uninsured residents have now secured coverage.
Nearly 135,000 are with Commonwealth Care, the subsidised programme that provides insurance to people who have no access to work-based coverage but earn less than three times the federal poverty level – about $31,000. The state pays the full premium for the lowest-income residents and subsidises the rest.
Another 73,000 are covered through expansions to MassHealth, the state’s free programme for its poorest residents, and about 10,000 are covered under Commonwealth Choice, which provides a suite of unsubsidised products for those individuals and small businesses ineligible for the other programmes.
Funding, however, remains a big concern as the rapid enrolment has made the plan more expensive than previous estimates. Writes Rebecca Knight
Eighteen months later, however, the image of Mr Romney celebrating the introduction of near-universal health insurance in Massachusetts alongside the godfather of US liberalism has become a source of embarrassment.
Opponents have posted video clips of the ceremony on the internet to undermine Mr Romney’s attempt to win the Republican presidential nomination. The fact that his success in pushing through bipartisan healthcare reform could be construed as a liability highlights the depth of suspicion among Republicans about government involvement in healthcare.
Democratic presidential candidates, including Hillary Clinton and Barack Obama, have put healthcare at the heart of their campaigns, with competing proposals to provide health insurance for the 47m US citizens without coverage. But while opinion polls show broad public support for government intervention, Republicans are much less enthusiastic than Democrats.
Only 16 per cent of Republicans rate healthcare among the top two issues in next year’s election, compared with 34 per cent of Democrats, according to a recent Quinnipiac University poll. A separate Washington Post/ABC survey also revealed a gulf in attitudes. While 71 per cent of Democrats said expanding access to insurance should be the top healthcare priority, 80 per cent of Republicans said reducing costs was most important.
For many US conservatives, government meddling in healthcare is viewed as an unappealing symbol of European-style “socialism”. The fact that healthcare reform is indelibly associated with Mrs Clinton, dating back to her time as US first lady, only deepens Republican scepticism.
All this helps explain why Mr Romney has been so hesitant about trumpeting his healthcare record on the campaign trail as he seeks to promote himself as a small-government, tax-cutting conservative.
Speaking in Iowa City recently, he expressed pride in Massachusetts’ scheme, which has already nearly halved the number of people in the state not covered by any healthcare plan. But his tone was defensive. “I don’t think it’s a perfect plan,” he said. “There are some things I would change.”
The Massachusetts model was designed to achieve universal healthcare by making insurance mandatory for those who can afford it, while providing subsidised coverage for the poor. Rival Republican candidates have likened the scheme to Mrs Clinton’s current proposals, and argued that forcing people to buy insurance infringes personal liberty. Rudy Giuliani, the Republican frontrunner, said it was a step towards “socialised medicine”.
Defending the scheme, Mr Romney said in Iowa that it was designed to reduce the burden on taxpayers by extending private insurance to people who previously relied on government-funded care. “My plans couldn’t be more different from Hillary Clinton’s,” he added.
Mr Romney made clear he would not extend the Massachusetts scheme nationwide if elected president. Instead, he would provide incentives for each state to make its own reforms. “I don’t think there is a one-size-fits-all answer,” he said.
While Republican candidates reject the sweeping reforms proposed by Democrats, they acknowledge action is required to make the system more efficient. All the main hopefuls want to make it easier for individuals to choose their own health insurance rather than relying on schemes provided by employers.
Although his experience in Massachusetts is unlikely to help Mr Romney win the Republican primary, it would be a powerful asset if he won the nomination.
Polls show healthcare is among the top concerns of independent voters, who could prove decisive next November, with Democrats the most trusted party on the issue by a wide margin.
Paul Eubanks, a 29-year-old independent in Iowa City, said Mr Romney was the Republican with the best chance of narrowing that gap. “His experience of pushing through healthcare reform, rather than just talking about it, is his biggest appeal,” he said.
Copyright The Financial Times Limited 2007
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