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Is Mitt Romney weaseling out on us?
Over the weekend, the former Massachusetts governor offered some comments on ObamaCare that are causing some folks to question how strongly the GOP presidential nominee remains committed to full repeal of the president's unpopular health care law.
Admission: Although I've never been a fan of Mr. Romney, I do reluctantly wish him victory, given how important it is to FIRE President Obama on Nov. 6th; therefore I want to read his comments as charitably as possible.
My own careful reading of those comments -- delivered yesterday on NBC's "Meet the Press" -- is that he does indeed remain committed to full repeal. But.
But ... he wants to do more than just repeal ObamaCare. He wants to replace it with ... what? Well, until yesterday, he's been a bit vague about that.
As I read them, yesterday's comments do not signal a backtracking on repeal. Rather, they shed light on what he'd replace ObamaCare with.
Now, he has long spoken of wanting to "keep the good parts" of ObamaCare," even as he has also sworn repeatedly that he would sign a full-repeal bill. Can these seemingly contradictory statements be squared? I think so. First, you repeal the whole thing. Then you enact what you think is better. (And you let people read the bill!) And perhaps what you think is better includes some things that were part of, or resemble, some of the things you repealed.
With a 2,700-page monster like the Patient Protection and Affordable Care Act, as amended by the 101 pages of embarrassing amendments known as the Health Care and Education Reconciliation Act, that's not inherently unreasonable -- depending on the details.
Obviously, the devil does live down there in the details.
But let's go to the tape.
Here's the full exchange, with NBC's David Gregory:
GREGORY: On health care, you say that you would rescind the president’s health care plan on day one. Does that mean that you’re prepared to say to Americans, young adults and those with preexisting conditions, that they would no longer be guaranteed health care?
MR. ROMNEY: Well, of course not. I say we’re going to replace ObamaCare. And I’m replacing it with my own plan. And, you know, even in Massachusetts where I was governor, our plan there deals with preexisting conditions and with young people. Everybody --
GREGORY: So you’d keep that part of the federal plan?
MR. ROMNEY: Well, I’m not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with preexisting conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like. I also want individuals to be able to buy insurance, health insurance, on their own as opposed to only being able to get it on a tax-advantaged basis through their company.
So what is the author of RomneyCare saying here? Is he saying, "I want to enact RomneyCare at the federal level"? I don't think so. (After all, Obama has basically already done that!)
What I think he's saying is, well, pretty much what it looks like:
1) He remains committed to full repeal.
This is the logical implication of two promises: 1) "[I] would rescind the president’s health care plan on day one." 2) "We’re going to replace ObamaCare."
That said, we do have to acknowledge that no president can by himself repeal anything. While a President Romney can stop some parts of ObamaCare's implementation via executive orders (beginning "on day one"), the vast bulk of the law can only be repealed by legislation (which always takes a while, even under the best of conditions). Happily, Mr. Romney has said on many occasions that he would sign such legislation.
The key, then, for us repealers, is to ensure, come November, we reelect a House and elect a Senate that can get that legislation to his desk early next year. The surest way to keep Mitt solid on full repeal is to elect solid pro-repeal majorities to Congress. We only need a net gain of 4 pro-repeal votes in the Senate to have a 51-vote majority there. This should be our highest electoral priority.
2) His own plan for "replacing" ObamaCare would include at least the following 3 things.
a) Legislation to "make sure people with preexisting conditions can get private insurance coverage."
This is perfectly acceptable. Nay, I would say addressing the problem of preexisting conditions is a policy and political necessity. But as always, HOW you do it is critical.
The problem of preexisting conditions is an artifact of current federal policy. Until the underlying policy is completely corrected and markets are allowed to function freely, the next best way to preserve the private insurance market is through minimal regulation and subsidies.
What Republicans must NOT do is revive any of the three most critical elements of ObamaCare, namely, the individual mandate to purchase health insurance, and the two big mandates on insurance companies, known as guaranteed issue and community rating. Those three pieces are the burning core of the government takeover of health care. Repeal them, and the rest of ObamaCare will eventually fall of its own weight. Since Mr. Romney is still clearly for repealing all three, we who are fighting for full repeal can still basically be comfortable with his position.
In my view, the best pro-patient, pro-market way to deal with the problem of preexisting conditions is to couple a minimal "continuous coverage mandate" with adequate funding for pre-existing conditions pools. In plain English, I mean this: 1) The federal government should require insurance companies to cover people who have been faithfully paying their insurance premiums and who have become sick through no fault of their own. 2) To help these unfortunate folks afford private coverage at market rates, taxpayers should provide what amounts to charitable subsidies through a state-based mechanism known to wonks as "high-risk pools."
Is this optimal? No. But is it a million times better than ObamaCare's government takeover? Absolutely.
Happily, Romney's comments can be squared with this approach.
b) Legislation to "assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they like."
This is a variant of ObamaCare's notorious under-26 mandate, which lets dependent adults up to age 26 to say on their parents' health insurance plan. Like all insurance mandates, it drives up costs. It is frankly an indefensible policy. Why stop at 26? Why not 36? or 66? It's silly. Romney's comments suggest he understands this logical flaw, but instead of stopping at 26, he would make it an unlimited right! To that extent, his position is more consistent than Obama's -- but also a heck of a lot costlier. Which means it would also be that much easier to stop. To be charitable to the governor, he needs to clarify his thoughts on this issue.
c) Legislation to enable individuals to "buy health insurance on their own, as opposed to only being able to get it on a tax-advantaged basis through their company."
This is tax equity, and it's essential to undoing the damage caused by current federal tax policy, which tilts the playing field heavily in favor of expensive group benefits in lieu of more economical, personally owned and portable individual coverage. In some ways, that unfair playing field is THE cause of our problems in health care: excessive medical inflation, lack of consumer consciousness, lack of portability of benefits, job lock, and of course the problem of people not being able to afford coverage due to preexisting medical conditions.
But again, HOW we go about achieving this worthy goal is important. If Romney is talking about creating universal health insurance tax credits, as technocrats like the conservatives at the Heritage Foundation have long urged, then he will be risking the resurrection of ObamaCare in a new guise. Such a "voucher-like" scheme will require exchanges, premium subsidies, mandates, etc., to make it work. If, however, Romney is talking about something more straightforward, such as 100% deductibility of all medical expenses (which FreedomWorks has championed), then it will be a strong move in the right direction.
The Bottom Line
With the exception of his remarks in favor of letting people stay on their parents' insurance policy, which need to be clarified, Romney's positions, as expressed on "Meet the Press" over the weekend, CAN be squared with his "full repeal, pro-patient" stance.
For now, I think supporters of patient-centered care should "trust but verify."
Let's give the author of RomneyCare the benefit of the doubt -- and keep a close eye on him.
And ... keep executing our Five Point Plan for Full Repeal.
Dean Clancy is FreedomWorks' Legislative Counsel and Vice President Health Care Policy. He leads our efforts to replace the government takeover with a patient-centered system.