by Robert I. Field, Ph.D., J.D., M.P.H.
Mitt Romney says his Massachusetts health reform plan is much better than Obama's. He claims it's different in important ways.
If there are big differences, it's difficult to find them.
In an interview last week with a Denver TV station, Romney cited the key features that differentiate his reform approach from Obama's.
He declared, "My health care plan I put in place in my state has everyone insured, but we didn't go out and raise taxes on people and have a unelected board tell people what kind of health care they can have."
Let's do some quick fact checking.
Does Romneycare have everyone insured? Close, but not fully there. The plan cut the state's rate of uninsurance by almost half. As of 2010, the rate was just over 6% for the nonelderly population, the lowest of any state. That's a huge accomplishment, but there is still a ways to go before everyone has coverage.
Did Romneycare raise taxes? No, but the state didn't need to. It covered the cost of reform with larger payments that it negotiated from the federal government for its Medicaid program.
Does Romneycare have an unelected board that tells people what kinds of health care they can have? It does. The Massachusetts Connector Authority serves as the state's insurance exchange. It sets standards for the types of plans that may be sold, thereby determining the kind of access residents will have to health care services.
Is Obamacare any different? Not really.
It will extend coverage to 30 million more people, which will reduce the country's rate of uninsurance by about half to roughly 8 percent. Not too different from Romneycare.
It does raise taxes in a number of ways, including new levies on tanning salons, medical devices, and high-end insurance policies. But, unlike Massachusetts, it doesn't have a higher level of government to turn to for help, so it needs a new source of revenue to cover the cost.
It does let unelected officials determine what kind of insurance people can receive by setting standards for coverage under the state exchanges that will sell it. Just like Romneycare.
Romney's comment about an unelected board was probably also a reference to a new board that Obamacare created called the Independent Payment Advisory Board (IPAB). It recommends cost-cutting measures under Medicare. Romney, along with several fellow Republicans, has complained about the scope of its power. But Romneycare is a state-based program while Medicare is purely federal. It couldn't have included an IPAB or any other measure concerning Medicare, even if Romney had wanted it to.
After all is said and done, these aspects of the plans are relatively minor, anyway. In their underlying structure, Obamacare and Romneycare are almost identical.
Both expand coverage in the same three ways. They reform the market for individual insurance by creating exchanges to sell it, subsidizing those with low incomes, and mandating that everyone maintain coverage in some form. They expand Medicaid to cover more people. And they penalize employers who don't offer coverage to their workers.
Romney and his fellow Republicans should be proud that Obama copied their health reform approach. Instead of drawing false distinctions between the two plans, they should boast of leading on health reform and leaving Obama and Democrats to follow.