I didn’t want to write the following – Romney was a terrible governor, he’d be a terrible president, and I hate to defend him. But fair is fair, and he’s taking a bum rap on this one. Read on for the details.
Poor Mitt! Everybody’s beating up on him for supposedly flip-flopping on health care, because the plan he helped negotiate – and still supports – in Massachusetts works the same way as the federal Affordable Care Act, aka “ObamaCare.” Both the Massachusetts and federal plans contain an individual mandate: a requirement that any individual not covered by some other health insurance must purchase an individual policy, or else pay a fine.
Without such a mandate, it would be very difficult to include an important feature of each plan, the rule that insurance companies may not exclude preexisting conditions from their coverage. The logic of this is simple: if you can’t be denied coverage for a preexisting condition, it would make sense to not buy any insurance until you get sick. Once you got sick, you could pick up a policy, as the insurer would not be allowed to refuse you.
The net effect would be that only people with high medical expenses would get coverage, which would therefore cost just as much as paying for treatment directly. The system would collapse under its own weight.
There are two ways to design a program to avoid this contradiction: either a single-payer system, where everyone is covered all the time by a government plan; or an individual mandate, which basically forces healthy people to get insurance.
So that’s why Romney’s plan included the individual mandate, and it is similar to Obama’s in that way. But there is a crucial difference all the same:
Romney’s plan individual mandate was an order from the state; Obama’s is an order from the federal government.
The issue is the Tenth Amendment, which says that any powers not expressly given to the federal government belong to the states. States clearly have the power to make people do things: wear motorcycle helmets, get immunizations, obey quarantine laws. The federal government has such power only when it is part of another power.
Now, I firmly believe that the Affordable Care Act is legitimate under the interstate commerce clause. There are 100 years of precedent for this, and only the right-wing nuts currently on the Supreme Court would quesion it. But that’s not what the Tea Party thinks: they maintain that the Tenth Amendement prohibits a federal individual mandate. That’s the basis of most of the pending lawsuits on ACA.
Romney’s position – and he did spell it out early in the campaign – is that the state of Massachusetts wanted to impose an individual mandate, and it had the power to do so. The federal government, in his opinion, does not. No flip flop there, just straightforward (albeit incorrect) constitutional reasoning.
Unfortunately, that argument is too sophisticated for the Tea Party folks to grasp.