JONATHAN COHN MARCH 2, 2011
Mitt Romney’s Republican rivals for president continue to pummel him over the health care reforms he enacted in Massachusetts. And my colleague Jonathan Chait is relishing every minute of it. Noting that Romney’s latest strategy “seems to be curling up into the fetal position and hope everybody gets tired of kicking him,” Jon remains convinced that Romney’s cause is hopeless: “My advice? “Find something to do other than run for president.”
Jon is probably right and, to be quite honest, I have no great enthusiasm for Romney these days. But I do feel compelled, once again, to speak up on behalf of Romney’s health care reforms. As I wrote a while ago:
There’s no disputing that the reforms have expanded coverage. During a period in which the proportion of Americans without health insurance has remained stuck at more than 15 percent, the proportion of Massachusetts residents without coverage has fallen dramatically, to below 3 percent, according to official figures. That is by far the lowest percentage of any state.
Of course, coverage by itself is meaningless if it doesn’t translate into more access to medical care or less financial hardship because of medical bills. And there is evidence, mostly anecdotal, that some people are really struggling under the new scheme, either because it’s tough to pay the insurance premiums or because, even with coverage, their medical bills are a burden. But the overall picture looks encouraging. According to a study that two Urban Institute researchers published this spring, the number of working-age adults reporting that they skipped care because of high costs fell from 17 percent to 11 percent in the first two years after the law took effect. The gap was even more dramatic among those eligible for subsidized insurance through the Connector--that is, people making less than three times the poverty line, or around $66,000 per year for a family of four. Among those people, the proportion skipping care because of cost fell from 27 percent to 17 percent. And that’s despite a rough leveling-off in the second year, most likely due to the fact that the recession meant lots of people were out of work and counting their pennies. When the economy rebounds, the number should decline even more.
The article and that Urban Institute study are getting a bit dated. But they are consistent with more recent information. The big flaw in the Massachusetts reforms remains what it's always been: It hasn't controlled the rising cost of medical care. But, for the umpteenth time, the architects of Romneycare (sorry, Mitt!) weren't trying to control the cost of medical care. They decided to address coverage first and cost later. The Affordable Care Act, by contrast, seeks to address both issues at once.
Perhaps the best testimonial for the Romney plan comes from its most recent critic. That would be Mississippi Governor Haley Barbour, who on Tuesday told a congressional committee that his state wanted nothing to do with Massachusetts-style reforms. "We don't want community rating. We don't want extremely high mandatory standard benefits packages."
Community rating, of course, is the practice of charging the same premium to different customers, even the diabetics and cancer survivors. “Extremely high mandatory standard benefits packages” in this particular case means insurance plans that cover what most of us would define as basic care, without gaps and loopholes that force the chronically and severely ill to pay exorbitant bills.
Insurance available to all. Benefits that include the services sick people need. Yeah, why would anybody want that?
P.S. Yes, I know conservative intellectuals have more sophisticated critiques of why community rating and higher benefits are a bad idea. I don't agree with them, for reasons I've stated multiple times. But I'm making a simpler point here: Most of the people Barbour is addressing probably don't realize he's against those things. They should be.
Update: Wonk Room's Igor Volsky responds to yet another attack on Romneycare, this time by House Budget Chairman Paul Ryan. Volsky notes, among other things, that the plan has been popular: In a September 2009 poll of Massachusetts residents, the most comprehensive I've seen, 59 percent of respondents said they supported the law and just 28 percent said they opposed it.