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On Birthday 6, Reflections on “RomneyCare”

Posted by John McDonough  April 12, 2012 10:25 PM

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Prior to Mitt Romney's 2012 presidential campaign, hardly anyone referred to Massachusetts health reform as "RomneyCare." As with "ObamaCare," it was a term of choice only for critics, most of them out-of-state. The libertarian Cato Institute began using it back in 2006. I recall former Boston Medical Center Chief Elaine Ullian using it early and often because she opposed the law's funding reductions for safety net hospitals. Not many more.

Those of us who worked on the law's passage and implementation never used the term for a simple reason. The law Romney proposed in 2005 differed markedly from the law approved by the Democratic-dominated Legislature in 2006. Romney wanted everyone to have access to flimsy, high-deductible coverage; the Legislature insisted on fuller coverage for those getting access to the subsidized Commonwealth Care coverage, and a choice of skinny or full for everyone else.

Romney was governor for less than nine months into the law's implementation. Most key decisions did not happen until 2007 after his departure and the arrival of Governor Deval Patrick who supported a more expansive version than did his predecessor. We were pleased Romney continued to support the law and promote it as a national model during his 2008 presidential run, though it was no big deal.

And still...


The image of Romney at the law's signing with his reform partner, Sen. Ted Kennedy, had legs. Romney had taken a conservative and Republican idea, the individual mandate, and did it for the first time in U.S. history. Kennedy legitimized the idea as an acceptable tool and policy choice for Democrats.

So while it is fair, as the conservative Pioneer Institute does in its new book, The Great Experiment, to talk about the many statutory and implementation details where Mitt Romney differed from the final Massachusetts health reform law, there is no denying the essential parallels between that law and Title I of the Affordable Care Act (aka: ObamaCare). These include:

  • Insurance market reforms
  • The individual mandate
  • Premium and cost sharing subsidies
  • The Health insurance exchange

It's true, as Romney asserts, that there is a lot, lot more to the ACA beyond these four elements. And, still, there is no denying that the essence of the ACA's pivotal Title I came straight from the law Romney that signed and Kennedy supported.

So on this 6th anniversary of Massachusetts health reform, thanks Mitt, thanks Ted, and thanks Mr. President.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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