Differences between RomneyCare and ObamaCare

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) 
Boston.com: RomneyCare - a revolution that basically worked
CommonHealth: Huge Similarities Between ObamaCare and RomneyCare
Investors.com: Real Cost of ObamaCare


  1. It certainly looks like Romney's plan generally has the upper hand on Obama's. Just about the only thing Obama's has on Romney's is aiming to lower healthcare costs. I'm curious to see how these plans will affect each man's chances in the upcoming elections.

    private health insurance

  2. Excellent article discussing the ACTUAL contents of the two bills...

    And one large difference not noted in the article, is the fact that over 70% of the people of Mass WANTED this bill passed... the exact opposite of Obamacare, where most polls put the percentage of Americans opposed at around 66%...

    Another is Romneycare was passed LEGALLY and through all the proper congressional channels. Obamacare was passed illegally and it took SCOTUS calling it a "tax increase" to get it to stand...

  3. The number of pages are somewhat irrelevant. Furthermore, the Mass. bill affects 6.5 million people. The federal bill affects 313 million people. When the bill is taken as a ratio of the population, the Mass. bill is longer.

    The cost is also misleading, as using the gross number elicits sticker shock while ignoring the fact that the Federal Government operates on much larger scales than any state government. Obamacare is expected to cost ~2 trillion over 10 years. Thus, assuming the yearly cost is constant, Obamacare will cost about 5% of the total yearly budget for the US. (total budget info from wikipedia) This is a higher percentage than the MASS. bill, but the scope is, as you said, much larger, as it does attempt to control costs.

    I also disagree that Romney opposed the RomneyCare individual mandate, because he signed that provision into law, while vetoing other mandates (such as the employer assessment.) He may have had reservations, but they were not strong enough for him to veto. Furthermore, here's a link where he seems to give begrudging approval of the result.


    1. Baachou-

      Understanding the Massachusetts line item veto is important here.
      The legislature put in the mandate and passed it.
      Romney vetoed it.
      The Legislature then had the ability to override the veto. (I believe they had to have a 2/3rds majority to do it.)

    2. This is wrong. Romney signed the individual mandate, but vetoed the employer mandate. The employer mandate was subsequently overridden by the house.

      This is one of many articles that supports this: http://seattletimes.nwsource.com/html/nationworld/2002927493_insure13.html

    3. I have the bill in my hand. It tells you what was vetoed and overridden. He vetoed the employer mandate. And Just for Kicks the bill is NOT 70 Pages it is 95 pages. So much for your above math problem

    4. Oh BTW what do you think of 1 in 6 not having to comply with the federal mandate. In my estimation that is 16%. Since 83% of Americans already have health insurance and 16% are exempt then we get a 1% increase in covered benficiaries at a cost of $1.4 TRILLION

  4. my thoughts on obamacare and liberty:


  5. You say in the similarities that RomneyCare extends Medicaid, and then in the differences you say it doesn't affect Medicaid.

  6. You quote the percentage still uninsured as a difference, but most provisions of ObamaCare that aim for universal coverage don't take effect until 2014.

  7. The 9% increase in premiums is a pretty typical yearly increase. Only 1-3% of that has actually been blamed on ObamaCare. Massachusetts insurance premiums increase every year, and they have long been the highest of anywhere in the country.

    Also, the difference regarding the individual mandate is unclear. Both have a tax penalty for uninsured individuals, right?

    Sorry to nitpick. I don't like either solution, but this page appears on the first page of a search for "Differences between RomneyCare and ObamaCare", so I'm just hoping you can make the chart a little more clear and accurate.

  8. Based on your analysis, it appears to be easier to pin exactly what Romney supported and didn't support vs what Obama wanted for his plan. As I recall, the Affordable Health Care Plan was changed greatly due to the many compromises for Republicans, who ultimately didn't support it anyway. So, either compare plans without indication of what the leaders may or may not have wanted, OR compare what Romney wanted and what Obama wanted. Assuming neither got exactly what they wanted.

  9. The differences you mentioned above are all cosmetic.

    The most important differences come in the formation ACO's, episodes of care and 40%excise tax on insurance premiums.

    The ACA mandates and has already modeled what they call ACO"S. Which are large conglomerates of healthcare providers including hospitals, physicians, nursing homes, and home health care. These will recieve a single payment called a "payment bundling". Payment is based on "episodes of care" in which the provider must follow the designated procedures outlined in order to be

    ASCO's also risk losing floor pay for accepting insurance that uses differing actuary tables from the government. This in combination with the 40% tax on "excess benefits" guarentees that the government insurance is the same as any private insurance. SO SINGLE PAYER!

    Romney's plan merged employers into groups to give them buying power through the comonwealth Connector.

    My sources are the Patient Protection and Affordable Care Act and Chapter 58 Common Laws of Massachussets

  10. I think the bias still shows.


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