Saturday, March 3, 2012

RomneyCare vs ObamaCare - differences and similarities

I did my own research on the similarities and differences between "RomneyCare and ObamaCare" and created the following table.
Essentially what I found was that RomneyCare was a hugely bipartisan effort and that it shows. I learned that Governor Romney vetoed many key aspects of the original bill, but was over-ridden by the legislature in the final act, and many of the items he opposed are the basis for ObamaCare.

The two laws are inherently different, but do have a few similarities. Romney funded his primarily with revenue from the federal government. The Obama method uses a mixture of new taxes and savings from changes to Medicare. The Massachusetts plan was designed to expand coverage to the roughly 60,000 uninsured in that state; Obama’s includes mechanisms to help control health-care costs.
There are several similarities between the two acts. I have done my best to remove any bias and present an honest comparison of the two laws.
If an error is found, please let me know in the comments section, and please provide a source for your information. I provide my sources at the bottom of this post.

RomneyCare- Massachusetts Health Care Insurance Reform Law 2006 ObamaCare- Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
Offers subsidies to residents with income up to three times federal poverty level Offers tax credit to Americans with incomes up to four times the federal poverty level.
Extends coverage to low-income state residents through federal-state Medicaid. Extends Medicaid eligibility to low-income Americans.
Eliminates annual caps on coverage, limits maximum amount that consumers pay annually. Eliminates lifetime and annual caps on coverage, limits annual maximum to consumers.
Requires employers with 11+ workers who do not offer insurance to pay a penalty. Requires employers with 50+ employees to offer insurance or pay a penalty if at least one of their workers receives a tax credit to buy coverage.
Makes investments to improve wellness, prevention, and public health. Makes investments to improve wellness, prevention, and public health.
Created online marketplace for small employers to compare plans and options, saving admin costs. Created online marketplace for small employers to compare plans and options, saving admin costs.

70 pages long 2,074+ pages long
Main goal: insure everyone in the state Main goal: regulate and control costs of healthcare industry
Did not raise taxes Creates new taxes of $500 billion on individuals and businesses
Does not cut Medicare Cuts Medicare by $500 billion
No affect on Medicaid Gives Medicaid more liberally
1.8% of state uninsured (provided opt-in, opt-out) 16.7% of US still uninsured
Romney vetoed employer penalty (legislature over-rode later) Penalizes and requires employers to offer different types of insurance
Cost the state 1% of budget Will cost $2 trillion
Puts responsibility on individual to buy insurance, while also creating employer penalty for not providing insurance. ($295 per person, but increases monthly (opposed by Romney) No mandate for individuals, creates tax incentives for individuals to purchase coverage (penalizes the uninsured)
Did not lower healthcare costs (did insure everyone) Main goal is to reduce healthcare costs (does so by passing the expense to employers)
Deregulated a complex overly regulated state program. It is still heavily regulated, but much less so. Raised the costs of private health insurance premiums by 9% in one year (even before enacted). Expected to eventually raise premiums 55-85%.
Romney opposed the Commonwealth Health Insurance Connector Authority, also known as the Health Connector. Among other roles, the Connector acts as an insurance broker to offer private insurance plans to residents. Obama plan is based around this regulatory exchange, imposing many requirements on what is considered “minimum creditable coverage” (for instance, contraception)
Romney supported a bare bones policy that covered hospitalization and catastrophic illness. Obama plan imposes several requirements on what is considered “minimum creditable coverage” (for instance- contraception)

Romney on the MassHealth Act, "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. That’s the wrong way. The Republican approach is to say, ‘You know what? 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."

Governor Romney vetoed sections 5, 29, 47, 112 113, 134 and 137 of the MassHealth bill. The legislature overrode all vetoes. 

Summary of the vetoes-
Section 5- Creation of a public health council.
Section 29- Provides coverage to non-citizens, but qualified aliens permanently in US. Provides coverage for dental services to adults in a federal optional program.

Section 47- Requires employers of more than 11 full-time employees to pay a per-employee "contribution" if uninsured.
Section 112-  Amendment seeking a waiver from federal government to implement the act. Details terms and conditions for Medicare and Medicaid reimbursement (from state to fed).
Section 113- Details requirements of behavioral health services and funding by Medicaid. (does not change services, just details how state collects funds) Determines which businesses qualify as behavioral health services.
Section 134- Requires a report by department of labor and division of health care finance and policy on effectiveness of new law.
Section 137- Requirements of the public health council (opposed in section 5). 

New Yorker: Romney's Dilemma (fascinating, highly recommend)
America Needs Mitt: RomneyCare vs ObamaCare
Massachusetts Legislature Website (actual bill) RomneyCare - a revolution that basically worked
CommonHealth: Huge Similarities Between ObamaCare and RomneyCare Real Cost of ObamaCare


  1. It's a toss-up between the two. What strikes me the most though is that while Romney's plan costs a mere 1% of the budget, Obama's needs $2 trillion to work. If Obama can lower that figure, then I think he'll have an advantage here.

    private health insurance

  2. I appreciate the article and have not done as extensive of research as you have presented here. But I wanted to point out two important problems in the comparisons :

    First is the cost of the plans, and its even misunderstood by the commenter above. The $2 trillion figure (which is the high estimate, likely quoted by an opponent of the bill) is spread out over TEN YEARS. The Romney bill is presented as a percentage of the ANNUAL budget. Change it from a percentage to a dollar figure, times that by ten, and we've got an accurate comparison. Except that of course absolute dollars are misleading since we're talking about one plan covering one state and the other covering 50. So the price of the bills is somewhat meaningless, especially as presented in this article.

    The second issue is that Romney's vetoes to the Massachusetts bill are factored into the comparison as almost a disclaimer. If that is necessary, then why not also include the Obama's actual intent on the bill when it was drafted versus what eventually passed congress. Republicans fought hard to toss out key provisions that were essential to the implementation of the bill AS IT WAS DRAFTED. What resulted was a much different and much less effective bill that was ultimately passed, containing many compromises that Obama and his staff were very upset with, and yet at the end of the day President Obama's name is attached to the ACA, just as Romney's name is attached to the Massachusetts law. We have to hold neither politician responsible for their respective bills, or both of them fully.


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