Families USA: The Voice for Health Care Consumers

ObamaCare versus RomneyCare versus RomneyCandidate Care
A National and State-by-State Analysis
A report from Families USA, a 501(c)(4) organization, September 2012

The development of this report was aided by Stuart Altman, the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management at Brandeis University; Jonathan Gruber, Professor of Economics at the Massachusetts Institute of Technology; and John McDonough, Professor of Practice at the Harvard School of Public Health and Director of the Harvard School of Public Health’s Center for Public Health Leadership.


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 Key Findings
 Full Report (pdf)
 Comparison Chart
State Charts
Infographics: 1 | 2 | 3

America is at a crossroads in terms of the direction it will take on health care.

To help illuminate the possible paths forward, Families USA has explored the positions and records of the presidential candidates. To do this, we looked at the health reform law enacted in Massachusetts under the leadership of Governor Mitt Romney (which we refer to as RomneyCare throughout this report), at the health care law passed by Congress and enacted under the leadership of President Barack Obama (which we refer to as ObamaCare), and at the public positions on health care taken by Governor Romney in his role as the Republican presidential nominee (which we refer to as RomneyCandidateCare). While RomneyCare and ObamaCare have substantial similarities, it is clear that RomneyCandidateCare represents a significant shift in direction, presenting an obvious contrast with both RomneyCare and ObamaCare.

Governor Mitt Romney signed the Massachusetts Health Insurance Law on April 12, 2006.1 In doing so, he proudly stated that the new law would expand health coverage and protections for people throughout the state. Less than a year later, the governor touted RomneyCare as a potential model for replication. In remarks to reporters after a speech to the Republican Study Committee in Baltimore on February 2, 2007, he said, “I’m proud of what we’ve done,” and added that the law, if successfully implemented, “will be a model for the nation.” 2

When RomneyCare was enacted in 2006, Massachusetts already had one of the lowest uninsured rates among the 50 states (10.4 percent3). However, as Governor Romney anticipated, RomneyCare significantly improved health coverage. According to the latest Census Bureau report, only 3.4 percent of Massachusetts residents are uninsured—an enviable record that is far better than that of any other state in the nation.4 As a result, policy makers in the nation’s capitol turned to RomneyCare as a model to inform and guide the design of national health reform.

On March 23, 2010, President Barack Obama signed into law ObamaCare, the Patient Protection and Affordable Care Act. ObamaCare is similar in many respects to RomneyCare. Both laws expand affordable health insurance options for middle- and low-income individuals and families through the creation of new health insurance marketplaces with consumer protections, as well as through public coverage. Indeed, an examination of key provisions of ObamaCare and RomneyCare demonstrates the clear parallels.

Today, as a candidate for President, Governor Romney has been emphatically critical of ObamaCare and has repeatedly stated his intention to repeal the law. Moving away from the Massachusetts reform model he signed into law, Governor Romney has signaled his support for a dramatically different set of proposals.

In fact, RomneyCandidateCare includes health policies that would make it difficult, if not impossible, for other states to move forward with reforms similar to either RomneyCare or ObamaCare. First, Governor Romney would repeal ObamaCare, including measures in the law that provide new protections for consumers with private insurance (such as banning annual and lifetime caps on coverage) and that expand affordable coverage options. Paradoxically, RomneyCare was built on a very similar foundation of protections and new coverage options.

Second, Governor Romney would repeal ObamaCare’s substantial premium tax credits that would help middle-class families purchase insurance in the new health insurance marketplaces. Instead, RomneyCandidateCare would enact a federal income tax deduction for the cost of purchasing coverage in today’s existing insurance markets. As documented on page 4, the proposed tax deduction would provide significantly less help to families than the tax credit offered under ObamaCare.

Third, Governor Romney has proposed converting the Medicaid program to a block grant while significantly reducing federal Medicaid funding provided to the states. Ironically, federal Medicaid dollars were key to the success of health reform in Massachusetts. By cutting these dollars, Governor Romney jeopardizes both RomneyCare’s future and the potential for enacting similar reforms in every other state in the country.

This report examines the similarities between ObamaCare and RomneyCare, and it presents the clear contrasts between ObamaCare and the governor’s currently articulated health positions in RomneyCandidateCare.

Similarities between ObamaCare and RomneyCare
To illustrate the similarities between ObamaCare and RomneyCare, Table 1 presents new national data showing the effects each approach would have if it were fully implemented nationwide in 2016. (That is, we contrast the projected effects of ObamaCare with the projected effects of nationwide implementation of a plan that is identical to RomneyCare.) These new national data include the number of middle-class and working families who would be eligible for premium tax credits, the value of those credits, the out-of-pocket health care costs families would face, and the number of uninsured people who would gain health coverage.

We selected 2016 for our new estimates because it is the last year of the next president’s term in office and because it is also when ObamaCare will be fully operational. Although some provisions of ObamaCare have already been implemented, the major provisions of the law that expand coverage begin to take effect in January 2014. For example, the key provisions that will help millions of Americans with the cost of health insurance premiums are not yet in effect. In the comparison of the number of uninsured, we look at both 2016 and 2022 in order to demonstrate how the gap between the two approaches grows over time.

Key Findings: ObamaCare versus RomneyCandidateCare
Our report provides tables with new national and state-level data that illustrate the starkly different effects of the two candidates’ current approaches to addressing health reform. Again, our analysis assumes that both ObamaCare and, in this case, RomneyCandidateCare, are fully implemented nationwide in 2016. Our candidate comparison includes data on the number of middle-class and working families who would be eligible for premium tax credits and the value of those credits, the out-of-pocket health care costs families would face, and the number of uninsured people who would gain or lose health coverage (looking at both 2016 and 2022 for the uninsured). Although the report’s tables provide data for all states, in our Key Findings, we highlight the results in states that are currently receiving disproportionate attention in the media.5

ObamaCare and Medicare
As part of our analysis of ObamaCare compared to RomneyCandidateCare, we also look at the impact of ObamaCare on Americans who rely on Medicare. The Discussion section takes a closer look at claims that Medicare benefits are cut to pay for ObamaCare, and it corrects misconceptions regarding the effects of the Medicare savings that are achieved under the law. In point of fact, ObamaCare actually extends the life of the Medicare trust fund, and it expands traditional Medicare benefits, as shown in our Key Findings. Specifically, we include state-level data on the number of Medicare beneficiaries who are receiving new, free preventive health services under ObamaCare and who are receiving new help in the Part D drug coverage gap known as the doughnut hole. Since some of ObamaCare’s key Medicare changes are already completely or partially operational, we base our Key Findings on the most recent annual data available from the Centers for Medicare and Medicaid Services (CMS). RomneyCandidateCare would repeal these new Medicare benefits.

As our data show, RomneyCandidateCare, compared to ObamaCare, would substantially increase the number of uninsured people across the nation; would leave millions of middle-class, working families with considerably higher out-of-pocket health care costs; and would take away significant preventive and prescription drug services for seniors and people with disabilities who rely on Medicare.

1 An Act Providing Access to Affordable, Quality, Accountable Health Care, Chapter 58 of the Acts of 2006, available online at www.lawlib.state.ma.us/subject/about/healthinsurance.html.  
2 Rick Klein, “Romney Distances Self from Mass. Health Plan,” The Boston Globe, February 3, 2007.  
3 U.S. Census Bureau, Table HIA-4, Health Insurance Coverage Status and Type of Coverage by State—All Persons: 1999 to 2009, available online at http://www.census.gov/hhes/www/hlthins/data/historical/.  
4 U.S. Census Bureau, Current Population Survey, CPS Table Creator data for 2011, downloaded on September 13, 2012, available online at www.census.gov/cps/data/cpstablecreator.html.  
5 These states are as follows: Colorado, Florida, Iowa, Michigan, Nevada, New Hampshire, North Carolina, Ohio, Pennsylvania, Virginia, and Wisconsin.