By Perry Bacon Jr.
Washington Post Staff Writer
Friday, April 13, 2007
As Mitt Romney aggressively courts conservatives in his bid for the Republican presidential nomination, landmark health-care legislation that the former Massachusetts governor signed into law about a year ago has been largely left out of his pitch.
Buoyed by leading the GOP pack in fundraising for the first three months of this year, Romney's campaign recently launched a series of ads in Iowa and New Hampshire, but they featured another aspect of his tenure as governor: vetoes of spending bills from the Democratic state legislature.
Romney said little publicly as Massachusetts officials yesterday announced key details of a law that would expand health insurance to 99 percent of the state's residents. When he does speak about the measure, which many on the right abhor as a classic example of big government, his comments are measured, even though when he signed it on April 12, 2006, he described the legislation by saying, "an achievement like this comes around once in a generation." His current lack of emphasis has surprised some of the people who worked on the legislation, who say it was not only Romney's most significant accomplishment as governor but a major public policy triumph.
"It was an incredible accomplishment, and Romney really drove this," said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who worked with the Romney administration on the plan. "I would have hoped he would be touting it more than he is. To me, it should be the accomplishment he's running on, and I don't see him doing that."
In his major speeches, including the announcement of his candidacy in Michigan in February, Romney has often omitted mention of the health-care law. When he does talk about it, he frequently complains about provisions the legislature added that he opposed.
At a closed-door meeting of the Club for Growth, a conservative anti-tax group, last month in Palm Beach, Fla., he soft-peddled his role in the bill, said Pat Toomey, the group's president. "He was very quick to say the final product was not what he had initially proposed to the legislature," Toomey said. "He was very open about saying this could be a better bill and other states might find some things and make them better."
Romney's tack is particularly striking because the law helped rekindle interest from states and in Washington in aggressive health-care reforms, after President Bill Clinton's politically damaging failure on the issue in the early 1990s left politicians of both parties cautious of the issue. Almost a dozen states are borrowing from the Massachusetts model, most notably California, where Republican Gov. Arnold Schwarzenegger's plan would require all of his state's residents to have health insurance, the most groundbreaking part of the Massachusetts law.
The measure Romney signed expands health care by enrolling more people in Medicaid, offering taxpayer subsidies for people who do not qualify for Medicaid but cannot pay the full price for coverage, and creating a tax penalty for people who can afford insurance but will not sign up for it.
Romney aides say he is not avoiding the plan. "Governor Romney speaks about health care wherever he goes," said Eric Fehrnstrom, a Romney spokesman.
In an interview with the editorial board of the Des Moines Register last week, for example, Romney said of the law, "It's not a perfect plan, but it's a very good plan."
Sally Canfield, the campaign's policy director, said Romney is not likely to create a plan for his campaign that would expand the Massachusetts model and require all Americans to get health coverage. He will instead propose that other states experiment with their own ideas. "We can get health care for all our citizens that's private, market-based health care," Romney told the Register.
But Romney has rarely emphasized the law in his presidential run the way he has other parts of his biography, such as his work as president of the organizing committee of the 2002 Winter Olympics in Salt Lake City. "He's got bragging rights," said one GOP Washington lobbyist who backs Romney and did not want to be quoted publicly criticizing his strategy. "I don't know why he's not talking about it."
Romney's action on health care was pushed by a coalition of liberal groups who were considering a ballot initiative to expand health coverage if the state did not do anything, but even Bay State Democrats say he played a major role in the law's creation.
Many of the law's core elements, including the requirement that all people in the state get insurance, were in Romney's original proposal in 2005. The Democratic legislature added many of its own ideas to the final law, including a $295 fee per employee for businesses who do not offer health insurance to their workers. Romney vetoed that provision but was overridden by the legislature.
Conservatives have long been suspicious of universal health-care plans with high costs and requirements that either businesses or individuals purchase insurance; some say that such plans violate the idea that people should be able to choose whether they want insurance and that costs hurt businesses.
Another controversial provision in the Massachusetts plan creates a board on health-care financing that must include one member of the state's Planned Parenthood office, something that will not help Romney with the GOP base's abortion opponents.
"This mandate is unprecedented," said Michael Tanner, a health expert at the Cato Institute, a conservative think tank in Washington. "It's the first time a state has said simply because you live there you must buy a specific product. If he wants to be the Republican who embraces Hillary-care, I don't think that's going to go hand in hand with him trying to portray himself as Ronald Reagan's heir."
In a Washington Post poll taken in February, 16 percent of Democrats cited health care as their No. 1 issue, compared with 6 percent of Republicans. But some Republican strategists say that even if the details are not perfect, Romney should highlight his work on the issue. "Any sort of government mandate, Republicans are going to take with a grain of salt," said David Winston, a Republican pollster not affiliated with any candidate. "But on the issue overall, Republicans have significant concerns, and the candidates are going to have to address it."
And candidates often use issues that their party is not known for to distinguish themselves -- most notably then-Gov. George W. Bush's focus on his restructuring of education in Texas during his 2000 presidential bid.
For now, Romney is keeping his distance from the law, which goes into effect July 1 and has proved a challenge to implement. Massachusetts officials initially sought to require everyone to get insurance, but they have created exemptions, worried they have not yet created plans that are cheap enough for all residents.
"Republicans and Democrats came together, and we found a way to get everybody insured in our state," Romney told a crowd in Manchester, N.H., in response to a question last week. "I'm pretty proud of what we've been able to do. Is it perfect? I hope so, but probably not. Other states will come up with ideas, at least as good as ours, perhaps even better, and we'll learn from one another."