By 2005, political elites were looking carefully at an Urban Institute study done for the Blue Cross Blue Shield of Massachusetts Foundation. The study, known as the “Roadmap” and financed by the foundation and Partners Health Care, called for both an employer and an individual mandate, depending on the option politicians selected, as well as tax subsidies and a shopping service. Blue Cross, the state’s largest health insurer, and Partners, the largest hospital system, had much to gain from this solution. Blue Cross would get new customers and Partners hospitals would get a new income stream to cover the uninsured people who showed up in their facilities. The mandate and its accessories were now ready for the political process.
Romney loved the idea that the online shopping service would transfer responsibility for health insurance to individuals, Lizza reported. A document distributed by his office explained that the organizing principles of the Massachusetts law were “a culture of insurance” and “personal responsibility.” When he signed the law in the spring 2006, then-Gov. Romney told the assembled witnesses to history:
It’s a Republican way of reforming the market. Because let me tell you, having thirty million people in this country without health insurance and having those people show up when they get sick, and expect someone else to pay, that’s a Democratic approach. The Republican approach is to say ‘Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free ride.’
Fast forward to Candidate Romney’s Michigan speech in May 2011, in which he outlined his own health care plan focusing on repealing and replacing the Affordable Care Act. “What Romney’s speech needs to say,” announced Politico’s headline, and the website then offered four possible messages: “I swear it’s different than Obamacare;” “Mea culpa, Sort of;” “Here’s why I could stomach the mandate;” and “Seriously, I’m offering something new here.”
Romney did not apologize for signing the law; instead, he invoked a states’ rights argument. While the mandate was good for Massachusetts, it might not be good for Mississippi, he argued, sprinkling his words with big-government overtones. The founding fathers did not want a “king-like structure” grounded in central government, Romney said, adding that, on his first day as president, he would sign an executive order to help states exit from the Affordable Care Act.
Fast forward again to February 2012. In a much-publicized talk at the Detroit Economic Club, Candidate Romney moved far away from the individual mandate and the model he once supported:
I will look at every government program and ask this question: Is this so critical that it’s worth borrowing money from China to pay for it? Of course, we’ll start with the easiest cut of all: Obamacare, a trillion-dollar entitlement we don’t want and can’t afford. It’s bad medicine, bad policy, and when I’m President, the bad news of Obamacare will be over.
But the media focused neither on Romney’s clever phrasing nor on the substance of what he said, and laced in stuff about the horse race that Romney might win. They sort of reported his positions on Medicare and Social Security. An AP story didn’t touch on Obamacare at all. The Detroit Free Press didn’t list health reform in its bullet points describing what was in Romney’s speech; its story said that no other details were available in the preview the paper got from the Romney campaign. The topic came up in pre-arranged audience questions, but the candidate tip-toed around it saying only “The first thing I’d say to him (Obama) is ‘You say you copied (the Massachusetts law,) how come you didn’t give me a call? I’d have told you what worked, what did not work.’”