Families USA released a report today authored by three health policy luminaries: Stuart Altman, Jon Gruber, and John McDonough. They compare what will happen under a fully-implemented ObamaCare, RomneyCare (a fully-implemented national version of the Massachusetts plan enacted under Governor Romney), and what would happen if Romney’s current proposals were enacted instead. The authors impishly call the latter possibility RomneyCandidateCare.
No one should be surprised that RomneyCandidateCare would be a huge step backwards for sick, low-income, and the uninsured. (I’ve written quite a bit about that here, and at www.healthinsurance.org/blog/.)
Throughout the primaries, Romney and every other GOP candidate thundered against ObamaCare. Vice presidential candidate Paul Ryan has called for repeal, along with $800 billion in additional Medicaid cuts over the next decade.
The 2012 Republican platform states: “Congressional Republicans are committed to its repeal; and a Republican President, on the first day in office, will use his legitimate waiver authority under that law to halt its progress and then will sign its repeal.”
Republicans also propose deep Medicaid cuts. Rather than cover 30 million people as ObamaCare would, the Republican platform would actually increase the number of uninsured. The same GOP-base legislators who produced the above platform would be the ones to write the fine print of Republican health reform legislation. We should take this emphatic language very seriously.
Things could have gone differently… Families USA documents the incredible similarities between the original RomneyCare and ObamaCare on every item for which state and federal legislation can be fairly compared. The two policies are at least fraternal twins if not identical ones. Gruber and McDonough should know. Both held important seats at the table in both Romney’s and Obama’s health care reforms. McDonough was Executive Director of Health Care for All, where he played a central role in the original passage of RomneyCare. He was then a Senior Adviser to a key United States Senate committee, where he helped to craft the health insurance expansions in ObamaCare.
For both reforms, Jonathan Gruber was responsible for much of the detailed statistical work to estimate how many people would be covered, and at what cost. (He’s a leading health economist at MIT. He has even written a graphic novel about health reform.) For Families USA, Gruber ran the numbers on what RomneyCare would look like if it were implemented on a national scale. Below is Table 1 of the results:
As you can see, RomneyCare and ObamaCare would cover almost exactly the same number of uninsured Americans. RomneyCare was actually more generous on some measures.
Families USA’s account of RomneyCandidateCare is inherently more speculative, because candidate Romney has sent so many mixed signals regarding what he would actually do. In effect, Families USA analyzes the effect of a policy that would repeal ObamaCare while providing new tax deductions to help people buy insurance on the individual and small-group market.
The details here aren’t great. Altman, Gruber, and McDonough find that Romney’s proposed tax policies lead RomneyCandidateCare to provide less generous support than ObamaCare does (an average of $2,490 vs. $4,231), and to half as many people (10.1 million vs. 20.3 million). ObamaCare also provides more stringent limits on out-of-pocket spending when people contract expensive conditions.
Families USA just so happened to provide a breakdown of the resulting implications in 2016 people living in particular swing states who buy small-group and individual health insurance policies. In Florida, for example, average spending on insurance premiums and out-of-pocket costs are estimated to be $5,651 under ObamaCare. The comparable estimate for RomneyCandidateCare was $10.543. In 2016, the authors estimate that 2.5 million Floridians would gain health insurance under ObamaCare. Under RomneyCandidateCare, the number of uninsured Floridians would actually increase.
It’s ironic and sad that Candidate Romney has so rapidly retreated from the excellent and humane legislation Governor Romney had helped shepherd into law. In part to appease a deeply conservative GOP primary electorate, Romney ran away from the greatest, genuinely admirable achievement of his political career. It’s too late to turn back now. Romney’s right turn to embrace regressive tax cuts and deep safety-net cuts was politically damaging. I get the sense that that former collaborators such as Altman, Gruber, and McDonough are angry about this unworthy turn. They should be.