Mitt Romney's health-care challenge: Did he pass his own test?

Former Massachusetts Gov. Mitt Romney Thursday defended the health-care reform he instituted in his own state five years ago, then pivoted to a stinging rebuke of President Obama’s health reform – even though the Romney plan served as the model for the national reform.

In delivering the much anticipated speech on health care, Mr. Romney was tackling head on the central challenge to his as-yet undeclared second run for the presidency: how to trumpet his legislative accomplishments as a state executive while casting himself as a lead critic of Mr. Obama’s health policy, a favored target of Republican leaders and voters.

If Thursday’s speech was an indicator, the logic of that dual stance may still elude the party faithful.

Romney laid out the framework for a new federal plan that he would institute after repealing the Obama-era law. He asserted that federal health reform should use free-market principles and allow states to chart their own paths, rather than the top-down structure he says Obama has imposed.

“Our plan was a state solution to a state problem and his plan was a federal power grab,” he said in remarks at the University of Michigan in Ann Arbor.

Both the Massachusetts law and the new federal law require individuals to purchase health insurance, a feature that is anathema to conservative philosophy. But Romney maintained there’s a key difference between his state’s reform and “ObamaCare”: The mandate in Massachusetts was aimed at preventing “free riders” from receiving health care without paying for it, while the federal mandate is an abuse of power, he said. By law, a hospital may not turn away a patient seeking emergency care.

Appeal to 'personal responsibility'

Romney framed the state-level mandate as a requirement that people take “personal responsibility,” a phrase that often appeals to conservatives. But conservatives object to the government mandate at all levels, not just federal. And Obama’s reform is also aimed at addressing the free-rider problem. Romney also asserted that the Massachusetts reform did not include tax increases, while the federal plan does.

Romney is a top-tier contender for the 2012 Republican presidential nomination, but if he is to win over a critical mass of the party’s conservative base, he needs to convince them that he is no longer the same man who governed Massachusetts for four years. So far, he’s not there. And it may not be possible. Were he to renounce the signature initiative of his time as governor, he would renew his image as a flip-flopper.

“Mitt Romney just gave a more articulate defense of ObamaCare than President Obama ever has,” wrote Avik Roy on the conservative National Review Online site.

Romney devoted the majority of his speech to his proposal for a replacement to Obama’s reform. He aims to boost competition in the insurance market, allow states more flexibility in how they expand access to health care, and make changes in the tax code that make purchasing insurance on one’s own as financially advantageous as buying it through one’s employer.

Romney said he would turn the federal-state Medicaid program for the low-income and disabled into a block-grant program, a fixed sum of federal money to the states. Romney did not address the other big federal health-care entitlement – Medicare, which provides coverage for seniors – but he said he would at a later time. He expressed appreciation for the budget plan put forth by Rep. Paul Ryan (R) of Wisconsin, chairman of the House Budget Committee, which also would block-grant Medicaid. But Romney added that he would do some things differently than Ryan, without elaborating.

Romney had laid out his plan to replace “ObamaCare” in an op-ed in USA Today online on Wednesday.

Refuses to back down

In his speech, Romney expressed a keen awareness of the political pressure he is under on the health-care issue, but he refused to back down. And at least one prominent supporter remained optimistic that the Massachusetts health-care reform would not prove fatal to the former governor’s campaign.

“Lots of Romney opponents argue that Massachusetts' plan sinks the Romney candidacy,” writes radio talk show host Hugh Hewitt on his website. “Take it from someone who was certain that Sen. John McCain's amnesty bill, Gang of 14 ploy, and campaign finance reform law would doom his candidacy: Voters look forward, not backward, and it is about the choice they are offered the week they are voting, not what a candidate did legislatively years earlier.”

Senator McCain of Arizona won the Republican nomination in 2008, despite some policy positions that flouted conservative orthodoxy. But that was before the rise of the tea party movement. Romney is competing in an environment markedly different from 2008. What’s true is that, when primary and caucus time arrives, Republican voters will respond to the choice they face. So far the perfect candidate has not emerged.