Mitt Romney's rivals are trying to tie him to President Barack Obama's national health care overhaul, but they're getting tangled up themselves in the process.
The rest of the Republican presidential field sees no essential difference between the health care law Romney enacted as governor and what they love to call Obamacare, and they contend it has brought nothing good to Massachusetts. But they're oversimplifying the issue, as is Romney in defending himself.
During Tuesday's debate in New Hampshire, Texas Gov. Rick Perry pressed Romney on his decision as governor to require residents to obtain health insurance and suggested doing so has forced insurance premiums up.
"Governor Romney, your chief economic adviser, Glenn Hubbard, who you know well, he said that Romneycare was Obamacare," Perry said. "And Romneycare has driven the cost of small-business insurance premiums up by 14 percent over the national average in Massachusetts."
But that's not the whole story. What Hubbard actually said, in a 2010 study he co-authored with two other economists, was that the Massachusetts plan's "main components are the same as those of the new (federal) health reform law." And while it is true that the average premium for an individual, employer-sponsored health plan in Massachusetts was 14 percent higher than the national average last year, that gap actually has shrunk since the Massachusetts law took effect.
According to the federal government's Agency for Healthcare Research and Quality, the average individual premium for employees at Massachusetts companies with fewer than 50 workers was $5,673 in 2010, or 14 percent higher than national average of $4,956. In 2006, the year the Massachusetts law was passed, the average premium was 16 percent higher than the national average.
Premiums are well above the national average in Massachusetts _ a state known for its Cadillac health care _ but that was the case for years before Romney signed the law. And since he signed the law, Massachusetts has drawn closer to the national average.
While premiums were increasing in Massachusetts, they also were rising everywhere else. In Texas, for example, premiums rose from $4,463 in 2006 to $4,829 last year.
As for Perry's assertion that, "Romneycare was Obamacare," Romney responded by telling Perry to take another look at Hubbard's quote. "Just because some people say something doesn't mean it's true," he said. The same could be said of New Jersey Gov. Chris Christie's statement, made Tuesday in endorsing Romney, that it is "completely intellectually dishonest" to link Romney's measure with Obama's. Both have a point, but both also overlook key details.
There are major similarities between the two laws, and Obama himself has called the Massachusetts law a partial blueprint for the federal plan. Central to both laws is the individual mandate _ individuals are required to carry health insurance, either through an employer, a government program or by buying it themselves. Those who refuse face fines.
Both laws imposed new rules on the insurance industry to protect consumers from having their coverage canceled or denied because of preexisting conditions, and both imposed requirements on employers. Under the federal plan, employers aren't required to offer coverage, but those with more than 50 workers could be hit with fines if just one of their employees gets government-subsidized coverage. In Massachusetts, employers with 11 or more full-time workers must offer coverage or pay a fine.
Oddly, the individual mandate _ the element of the law that angers conservatives the most _ started out as a Republican idea when the issue came before Congress in the 1990s.
And as Romney points out, the Massachusetts law passed without imposing price controls on insurance companies or raising taxes. Obama's plan does not impose price controls on insurance companies. But it does provide closer regulation, including scrutiny of premium increases in the individual market. And beginning in 2018, it slaps a tax on high-cost health insurance plans.
During the debate, Romney also defended the Massachusetts law by citing how strongly the state's residents support it.
"The truth is, our plan is different, and the people of Massachusetts, if they don't like it, they can get rid of it. Right now, they favor it 3 to 1." That is true, according to a poll released in June by the Harvard School of Public Health and The Boston Globe.
Less accurate was Romney's suggestion that the Massachusetts law has dramatically reduced the number of uninsured children in the state, while he blamed Perry for Texas' high rate of uninsured kids.
"We have less than 1 percent of our kids that are uninsured," Romney said. "You have a million kids uninsured in Texas. A million kids. Under President Bush, the percentage of uninsured went down. Under your leadership, it's gone up."
According to the state of Massachusetts, 99.8 percent of the state's children had health insurance in 2010. According to the U.S. Census bureau, 3.8 percent of Massachusetts children under age 18 were uninsured in 2010, the second lowest rate in the nation, but Massachusetts also had one of the lowest rates before Romney's changes.
In Texas, 16 percent of children were uninsured in 2010, the nation's highest rate, but down from 23 percent in 2000, when Perry took office. As for Bush, Perry's predecessor, the rate of uninsured children rose 1 percent during his two terms.