The universal health care that Mitt Romney passed as Massachusetts governor has proven to be a popular target for his critics. But it could be Romney’s good luck that his two main establishment rivals for the GOP nomination are less than ideally positioned to capitalize on this liability.
When they set out to reform health care in their states, both Jon Huntsman, former governor of Utah, and Tim Pawlenty, former governor of Minnesota, considered the same tools that Romney adopted, including a mandate that people obtain health insurance and a state “exchange” where they could buy it. Both men ended up settling for reforms far more limited than Romney’s. But their records have left them open to charges of hypocrisy when they blast the Massachusetts and national health-care laws.
Though Pawlenty shrank from attacking Romney over health care at a recent candidates’ debate, he has continued to savage the Massachusetts law during campaign appearances, noting that it served as the model for the national law signed by President Obama.
“One of the major issues in the race is going to be Obamacare, and I don’t see how you can prosecute that charge effectively if you were co-conspirator in a charge,” Pawlenty told a TV interviewer in a typical line.
Huntsman is more measured in his criticism, saying Romney has “little credibility” on health care.
For his part, Romney could argue that his efforts left many more constituents with insurance. In Massachusetts, all but 2 percent of residents now have health coverage. In Utah, the figure is 14 percent, while in Minnesota, it has risen from 6 percent in 2000 to 9 percent.
People in both parties in Utah and Minnesota say they are surprised to see the candidates going after Romney’s record on the issue. The fact is, they say, all three were considering, to varying degrees, many of the same health-care reforms — ideas that were considered open for discussion in Republican circles before they became identified with the new national law.
“It’s tricky for [Pawlenty] because he was for a number of these ideas before he came out against them. There are lot of things we looked at in 2007 and 2008 that are embedded in the Massachusetts reform” and national law, said Erin Murphy, a Democratic state representative in Minnesota. “I’m surprised he’s pushing on health care, because it’s a political weakness for him.”
In Utah, Peter Knudson, a Republican state senator, said Huntsman should “not throw rocks at Governor Mitt Romney. . . . We are not a carbon copy, but I would certainly have to say we looked very closely at [the Massachusetts] plan.”
In Utah, health-care reform advocates recall their excitement when Huntsman declared in 2006 that the issue would be a top priority. There was clear inspiration from Massachusetts, where Romney, Huntsman’s friendly rival, was presiding over the historic overhaul. And there was encouragement in Salt Lake City as well, where a United Way task force, with many businesspeople on board, strongly endorsed expanding coverage.
The task force produced recommendations that mirrored the ambitious ideas being discussed by Huntsman’s health-care advisers — a regulated state “exchange” where people could buy insurance, along with an individual mandate for insurance, to reduce the number of “free riders” and make it affordable for insurers to offer coverage to people with preexisting conditions.
“I think if you’re going to get it done and get it done right, [a] mandate has to be part of it in some way, shape or form,” Huntsman said in a 2007 interview for a documentary.
The legislation that passed in 2008 was far more modest. The new exchange was open only to employees of small businesses that opted to take part. And there was no requirement that Utah residents get coverage.
On the trail, Huntsman now describes the rejection of the mandate as his decision.
But in Utah, people in both parties recall it differently: Huntsman’s team was quite interested in the mandate, they say, but it quickly became clear that it was going nowhere in the conservative legislature. And insurance brokers in the state lobbied against an exchange that would be open to more people.
State lawmakers “were very resistant to the mandate on philosophical grounds,” said David Sundwall, Huntsman’s health director. “It was not going to happen in Utah, and while that was disappointing, it was not something we were going to fall on our sword for.”
Advocates of health reform in Utah still praise Huntsman’s commitment to the issue, particularly his push to make permanent eligibility levels for the federal Children’s Health Insurance Program.
The exchange, the centerpiece of the 2008 reform, remains a work in progress. After a slow start, 314 businesses, with about 3,500 employees, are participating, while 390,000 state residents are uninsured.
“Over the time the number of people covered will continue to grow, not through government dictate but because they will have access to more health-care choices that make sense to them,” said Tim Miller, a spokesman for the Huntsman campaign.
In Minnesota, Pawlenty faced a different landscape as a Republican governor working with a Democratic-controlled legislature. But after his narrow reelection in 2006, he too spoke in ambitious terms about health-care reform. In a speech that November, he referred to an individual mandate as “potentially helpful” and a “worthy goal and one that we’re intrigued by and I think at least open to.”
Fourteen months later, in early 2008, a health-care task force he helped appoint recommended an expansive list of reforms, including a state exchange, an individual mandate and subsidies for those who couldn’t afford coverage.
But by that point, Pawlenty was saying the state needed to focus on controlling costs before expanding coverage. The legislation that passed in 2008 included funding to address chronic diseases and reforms to reward high-quality providers but no exchange and no mandate. In his last year in office, Pawlenty turned hard against the new national law, rejecting federal money to start implementing it.
On the trail, Pawlenty frequently touts his health-care record, particularly his move to encourage state employees to seek out efficient providers.
Minnesota lawmakers say Pawlenty is on more solid ground than Huntsman in attacking the mandate, because, with an eye to the national political scene, he clearly spurned it after the early statement of interest. More problematic, some say, is that the national law includes so many of the cost-control tools that Minnesota has helped pioneer, such as “bundling” payments for certain health conditions and encouraging the formation of “accountable care organizations” that are incentivized to deliver low-cost care.
Others say that Pawlenty’s bigger vulnerability is that his health-care reforms amounted to so little.
“The problem with Pawlenty was the follow-through,” said Larry Jacobs, a political scientist at the University of Minnesota. “There were many good ideas, but there was little that came into place.”
Meanwhile, the percentage of people without insurance has grown, including among children. This is attributed mostly to the recession, but also to state budget cuts. Last year, Pawlenty terminated the state program that covered 32,000 low-income people not eligible for Medicaid. It was replaced by block grants to hospitals, but only four hospital systems agreed to take part, leaving about half of the people in the program with nowhere to go.
Cal Ludeman, Pawlenty’s commissioner of human services, notes that Pawlenty approved a slight expansion of Minnesota Care, through which people without coverage at their workplace can buy subsidized insurance. And he rejected the notion that Massachusetts’ lower uninsured rates are a sign that Romney did more than Pawlenty.
“Any state could close that gap if they’re willing to use public funds,” he said. “Governor Pawlenty would probably look at Mr. Romney and say, ‘Can Massachusetts afford what it covers?’ ”