Mitt Romney's Long, Careful Health Care Evolution

Mitt Romney's positions can appear confusing. Here's a detailed look at his painstaking political shift, and the forces driving it.

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Mitt Romney is running for president in part on a staunch opposition to a national health care plan that bears a striking resemblance to the landmark legislation he signed in April of 2006. In particular, they share an individual mandate aimed at spreading cost and risks by forcing healthy and unhealthy alike to buy insurance.

Romney has faced sharp criticism in recent weeks, however, over a series of 2009 videos and op-eds, the majority of them highlighted by BuzzFeed News, in which he seemed to suggest that elements of his Massachusetts plan — including the mandate — could indeed serve as a national model.

An intensive examination of Romney's statements on healthcare reveals a clear path from that celebratory April, 2006 bill signing to the moment in April 2010 when Romney and his staff pivoted finally away from using RomneyCare as a national model. Romney has never backed away from his own plan, but instead focuses on the role of the federal government, which he now says should have no place in health care. But Romney's path, which tracked a hardening Republican reaction against Obama's plan, appears to be the considered political calculation of an experienced candidate, and a glance back at his words show it unfolding in real time.

Between President Obama's November, 2008 election and a comment from his spokesman in April of 2009, Romney appeared to shift from suggesting that Romneycare could go national to opposing that possibility; and toward adopting the new conservative line that the individual mandate is unconstitutional.

The early Romney position surfaces in a January 29, 2009 appearance on Your World with Neil Cavuto, Romney said health care reform should take "a free market personal responsibility approach to health care," adding" "we have answers that will help America, hopefully Barack Obama will listen to some those and adapt some of them."

Republicans were then shaping their reaction to Obama's nascent, promised health care reform, and divided on the question of whether to offer an alternative, or to just say no to what many saw as out-of-control government expansion. And Romney's clearest suggestion that his plan could represent a Republican alternative came the next day, in a January 30 speech to the House Republican Conference retreat at the Congressional Institute in Hot Springs, Virginia. There, Governor Romney said his plan could be the basis for a Republican proposal for national health reform. Romney said the plan could be based on market dynamics, free choice, and personal responsibility, a phrase typically used to refer to individual mandate that was a pillar of Romney's Massachusetts plan.

In an speech to the CPAC on February 27, Romney said, "We need to advance a conservative plan – one based on free choice, personal responsibility, and private medicine; one that doesn't add massive new federal spending. I like what I proposed in Massachusetts when I was governor. And even though the final bill and its implementation aren't exactly the way I wanted, the plan is a good model." But Romney added "We may find even better ideas in other states. But let's make certain that conservative principles are front and center. A big-government takeover of health care is the next thing liberals are going to try, and it's the last thing America need." It made the idea if Romney was advocating Romneycare on a national stage ambiguous.

That March, Obama launched his drive for reform at a White House forum and health care became a polarizing issue.

In May, Romney wrote an op-ed that appeared in Newsweek in which he outlined his ideas for health care reform, largely based off his Massachusetts plan, including an individual mandate. By then, the debate had already begun to harden, and in the op-ed Romney made clear that reforms should be based at the state level.

On June 1 speech at
the Heritage Foundation
Romney thanked Heritage for helping craft health care reform in Massachusetts. Romney went on to say that its influence on health care would be even more necessary in the national health care debate.

On June 14 Romney a appeared on This Week on ABC and said the President could learn from RomneyCare saying, "I understand the President considers his plan in respects following the model of Massachusetts lets learn from our experience."

Also in June 24 Romney said on The Early Show said of the President reviving the exchanges put in place in RomneyCare, "we put together an exchange, and the president's copying that idea. I'm glad to hear that."

In a June 29 appearance on "Meet the Press," Romney touted both his plan and the Wyden-Bennet plan as models for national health care reform. Both plans include a individual mandate.

On July 30, Romney wrote an op-ed in USA Today specifically saying the President could learn a thing or two from the plan he signed into law in Massachusetts, including using the individual mandate as an incentive for people to buy insurance.

One day later, on July 31, Romney gave an interview with Human Events where he spoke specifically about ending the practice of free riding, saying: "At the same time, we have to recognize that there are two major challenges which our health care system faces. The first is that we have a number of people who don't have insurance -- some choose not to, they're free-riders on other people and that we should end, and, secondly, our health care costs are going through the roof, and that also can be dealt with and improved, and I'm convinced that's a topic that should be part of this overall health care reform. "

But Romney added later in the interview "So, this whole area of incentives, with HSAs, coinsurance, single fees for providers, this is an area that I think is really ripe for analysis and, if you will, some experimentation. If the states would be the laboratories of democracy, I'd love to see some of these things tried at the state level before we launch them nationally."

By September Romney had clearly backed off advocating his plan as national model, but continued to the raise aspects of the plan he put in place in Massachusetts.

On September 19 Romney appeared at the Value Voters Summit where he spoke positively about his health care reform bill in Massachusetts. Romney didn't talk about the individual mandate or keeping reforms at the state level. "This Republican worked to reform health care in my own state. Not every feature of our plan is perfect, but the lesson it teaches is this," Romney said. "We can get everyone insured, without breaking the bank and without a government option—there is no government insurance in my Massachusetts reform. The right answer for health care is not more government, it's less government."

In October 28 interview on CNN, Romney told Dr. Sanjay Gupta that his plan did not reduce health costs in Massachusetts saying "Massachusetts is not the model" to reduce cost.

In December, Romney defended his plan from attacks from Tim Pawlenty to CNN host John King "There's no government option," Romney said "What's primarily wrong with the president's plan is that he wants to get the federal government into the health insurance business. It's going to require massive subsidies, a trillion dollars of costs down the road.That is not the right way to go. Instead, let states solve this problem and let them find their own plans."

On January 8, 2010 Romney appeared on "On the Record" and mentioned his support for a federalist approach to health care saying "The first is, issues like getting everybody insured should be solved at the state level, not at the federal level with a one-size-fits-all plan that's put together by Congress. That's No. 1."

On February 18 Romney remarked at CPAC that health care reform should be accomplished at the state level. "Strong families will have excellent healthcare. Getting healthcare coverage for the uninsured should be accomplished at the state level, not a one-size-fits all Pelosi plan," Romney said. "The right way to rein-in healthcare cost is not by making it more like the Post Office, it's by making it more like a consumer-driven market. The answer for healthcare is market incentives not healthcare by a Godzilla-size government bureaucracy!"

On March 5 Romney told Greta Van Susteren in an interview on Fox News on health care: "Well, the first issue on health care is, of course, to get everybody insured, and that is best done at the state level. This is a federalist system, meaning states have rights here. Let states create their own plans. We created one in Massachusetts. There are good things about it. There are some that are not so good. We can learn from each other, but that we do not need the federal government telling all of us to follow a federal plan.

On March 22 after ObamaCare was passed Romney wrote in National Review Online that the plan was an "unconscionable abuse of power." Romney went on to say "His health-care bill is unhealthy for America. It raises taxes, slashes the more private side of Medicare, installs price controls, and puts a new federal bureaucracy in charge of health care. It will create a new entitlement even as the ones we already have are bankrupt. For these reasons and more, the act should be repealed. That campaign begins today." But made not mention on the individual mandate

After health care reform was signed into law on March 23, Romney seemed to briefly re-embrace the mandate as a model for health care reform, noting his fondness for it in two interviews on his book tour and only called for a partial repeal of the bill.

On March 31, Romney spokesman Eric Fehrnstrom told Talking Points Memo, "Governor Romney likes the idea of exchanges where people can shop for affordable private policies. That was part of his Massachusetts plan."

In an April 4th interview with the Emory University student run newspaper The Emory Wheel, following a stop at the university on his book tour Romney praised President Obama for the similarities between ObamaCare and RomneyCare. Romney commented the "best features" of the President's plan were those similar to RomneyCare, including the "individual responsibility for getting insurance," commonly referred to as the individual mandate.

Also in early April, after ObamaCare was passed, Romney responded to a question at Vanderbilt noting the similarities between his plan in Massachusetts and President Obama's by saying, "I like some of the similarities, I dislike most of the differences."

Romney remarked that both plans "we have an incentive for people to become insured," also known as the individual mandate

Romney concluded "some similarities, some differences. And I hope we'll be able to eliminate some of the differences. Repeal the bad and keep the good."

After Romney and his Free and Strong America PAC launched a campaign to repeal "the worst aspects of ObamaCare" conservative blogger, Kavon Nikrad, frustrated by his failure to get an answer from Romney's staff on the question of what "repeal" actually meant, cornered Romney at a book signing in mid-April.

I was one of the first in line to the book signing, and when my turn came I asked Gov. Romney if I could ask him a question. After he told me that this was OK, I posed the following question to him:

"You have stated your intention to spearhead the effort to repeal the 'worst aspects' of Obamacare, does this include the repeal of the individual mandate and pre-existing exclusion?"

The Governor's answer:


Gov. Romney went on to explain that he does not wish to repeal these aspects because of the deleterious effect it would have on those with pre-existing conditions in obtaining health insurance.

Following conservative backlash over the incident Romney spokesman Eric Fehrnstrom emailed Ben Smith, then at POLITICO, "Mitt Romney has been very clear in all his public statements that he is opposed to a national individual mandate. He believes those decisions should be left to the states," and then later emailed that the mandate "should be repealed."

That email seemed to represent a final decision to stop the political bleading and cauterize the wound. For the last 23 months, Romney has been consistent: He has embraced repeal of the mandated, and stopped making references to the similarities between his plan and President Obama.