(Octavian Cantilli, Reuters)

“If you look at cap-and-trade, Gov. Romney was very proud to say that he was the first state in the country as governor to sign a cap on CO-2 emissions, the first state in the country to put a cap believing in global warming — and criticized Republicans for not believing in it.”

— Rick Santorum, during NBC News debate in Tampa, Jan. 23, 2012

“When he was governor of Massachusetts, he put forth ‘RomneyCare,’ which was not a bottom-up, free-market system. It was a government-run healthcare system that was the basis of ‘Obamacare.’ And it has been an abject failure, and he has stood by it. He's stood by the fact that it's $8 billion more expensive than under the current law. He's stood by the fact that Massachusetts has the highest health insurance premiums of any state in the country; it is 27 percent more expensive than the average state in the country. Doctors — if you're in the Massachusetts health care system, over 50 percent of the doctors now are not seeing new patients -- primary care doctors are not seeing new patients. Those who do get to see a patient are waiting 44 days, on average, for the care.

  A lot of those people were, as you know, on Medicare and Medicaid, so they're already on government insurance, and you just expanded it, in fact. Over half the people who came on the rolls since you put ‘RomneyCare’ into effect are fully subsidized by the state of Massachusetts, and a lot of those are on the Medicaid program.”

 -- Santorum, during CNN debate in Charleston, S.C., Jan. 19, 2012  


These quotes represent some of the most pointed attacks Rick Santorum has made against Mitt Romney during the past two debates, as he tries to portray the two GOP frontrunners as moderates — he dished out similar cap-and-trade criticism toward Newt Gingrich during the Tampa debate. (We have previously examined Gingrich’s flip-flop on this issue.)

The first set of remarks draw a distinction between Santorum and Romney on environmental issues. The second is a detailed litany suggesting the former Bay State governor doesn’t stand a chance of distinguishing himself from President Obama when it comes to health care during the general election.

We researched Romney’s stance on cap-and-trade and examined the effects of the Massachusetts health-care law to find out how close Santorum’s remarks came to the truth. We already wrote about the Massachusetts health-care overhaul in our biographical series about Romney, but we’re always willing to dive a little deeper on that subject.

The Facts

A Wall Street Journal article from October 2011 noted that Romney strongly supported cap-and-trade while serving as governor of Massachusetts. It reports that he stood outside an old coal-fired plant in 2003, promising activists, “I will not create jobs or hold jobs that kill people, and that plant, that plant kills people.”

Romney later bragged about signing the only cap-and-trade bill among the states in 2005, saying Massachusetts was “the first and only state to set CO2 emissions limits on power plants.”  

In terms of health-care reform, it’s true that the Massachusetts law expanded subsidies, but Santorum goes too far in calling it a “government-run health-care system.” The vast majority of Bay State residents -- 81 percent -- still use some form of private insurance, according to a report from the Massachusetts Department of Health Care Finance and Policy. Couple that with the fact that the program doesn’t include price controls, and it looks like a decidedly free-market plan.

Santorum’s claim about an alarmingly high increase in costs comes from a report by the conservative think-tank Beacon Hill, which determined the price tag of the changes to be about $8.6 billion since they took effect.

The non-partisan Massachusetts Taxpayers Foundation came up with a drastically lower increase of $707 million over the same period. The foundation didn’t count health-care funds that the state reallocated toward its reform program from other health-care-related areas, which helps explain part of the difference in calculations.  

Santorum said Massachusetts tops the charts in terms of high premium costs, and a Kaiser Foundation database supports his claim, showing that the average Bay State premium in 2010 was $437 per month, higher than all other states, and more than double the national average. The numbers come from insurer filings with the National Association of Insurance Commissioners.

But 2010 data from the National Conference of State Legislatures shows that Massachusetts trails a handful of states and the District of Columbia in terms of highest premiums for single and family coverage. The takeaway, based on those two reports, is that Massachusetts is well above average, but not necessarily worst in the country. 

In terms of accessibility and waiting times, Santorum appears to be partially right. A report from the Massachusetts Medical Society shows that the average wait time for internal and family medicine was 44 days in 2009. Family medicine dropped to 36 days in 2011, but internal medicine rose to 48 days, and more than half of primary care physicians are no longer seeing new patients. Regardless, these issues pre-date “RomneyCare.” 

As for whether Massachusetts fully subsidizes more than half of its newly insured, the answer is no. Seventy-two percent of the newly insured use some form of fully subsidized program, but the lion’s share of that growth occurred in eligibility categories that pre-date the reforms.

 We’ve calculated that 29 percent to 33 percent of the state’s newly insured receive fully subsidized health coverage as a direct result of the health-care overhaul, based on numbers we gathered from the Massachusetts Division of Health Care Finance and Policy and the Massachusetts Medicaid Policy Institute. The rest buy private insurance, receive partial subsidies, or use older forms of government assistance that were available before the reforms took effect.

The Pinocchio Test

Santorum was correct about Romney supporting cap-and-trade as governor of Massachusetts, so we can’t fault him there.

We do find fault with Santorum’s comments about the rising costs of Massachusetts insurance premiums and the state’s health-care expenditures. Some reports suggest the increases are out of control, while others say they’re not so bad, or even starting to slow. In this case, the former senator chose the report from a conservative-leaning organization that probably has an agenda similar to his own.

We found flaws in all of Santorum’s other “RomneyCare” comments: his suggestion that the Bay State reforms represent a government takeover; his insinuation that waiting times took a terrible turn for the worse after the program took effect (a classic scare tactic for politicians opposed to “socialized medicine”); and his claim that the state fully subsidizes most of its newly insured.

On balance, Santorum earns two Pinocchios for his pointed attacks against Romney during the past two debates.  

Two Pinocchios

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