Mitt Romney's Health Care Evasions

Is Mitt Romney trustworthy on health care? He's never been particularly convincing when defending his state-based health care overhaul against the president's remarkably similar federal plan. But his disingenuous arguments suggest that he probably can't be trusted to take on other problematic health programs, like Medicare, either, despite promises to reform them.

At last night's GOP debate, the former Massachusetts governor once again attempted to put some space between RomneyCare, the state-driven health care overhaul he signed in the Bay State, and ObamaCare, the federal health care overhaul that used the Massachusetts plan as its model.

Here's how he attempted to distinguish the two:

If you think what we did in Massachusetts and what President Obama did are the same, boy, take a closer look, because, number one, he raised taxes $500 billion, and helped slow down the U.S. economy by doing it. We didn't raise taxes.

This is true as far as it goes. But it's not the whole story. Romney didn't pair his health care overhaul with a large tax hike. He didn't have to, though, because he relied on generous help from the federal government to pay for it.

As The Beacon Hill Institute, a Massachusetts-based think tank, noted in June, RomneyCare only survives on federal crutches. "The federal government continues to absorb a significant cost of health care reform through enhanced Medicaid payments and the Medicare program," the report's authors wrote. Most of the federal help goes to pay for the law's Medicaid expansion. According to the Cato Institute's Michael Tanner, the Bay State receives, on average, about $300 million a year in bonus Medicaid funding from Washington. All told, the Beacon Hill Institute reports that the feds have kicked in more than $2 billion to keep the program afloat, with lots more to come.

Nor is Washington the only source of bonus funding that Massachusetts lawmakers have sought out as a consequence of RomneyCare. Back to Tanner:

Romney's successor was forced both to cut back on some benefits that the plan originally offered and to raise the state's cigarette tax by $1 per pack ($154 million annually) to help pay for the program. The state also imposed approximately $89 million in fees and assessments on health-care providers and insurers.

Why did Massachusetts require all that extra funding? Because RomneyCare wasn't cheap, or even as cheap as expected. It ran over-budget fairly early on, and, according to Beacon Hill's report, has coincided with a $414 million rise in state health expenditures, $2.4 billion in extra federal Medicaid funding, and a $1.4 billion rise in Medicare spending.

Romney typically responds to complaints about the program's cost overruns by saying that the program accounts for only one percent of the state's budget. But looking only at the on-budget cost to the state ignores the considerable federal spending that makes the program possible.

Meanwhile, Romney's repeated evasions on his own plan make it awfully hard to trust him when he claims, as he did in last night's debate, that he'd "reform Medicare and reform Medicaid…to get them on a sustainable basis" for those who are still a ways off from retirement. Trusting Romney becomes even more difficult when he simultaneously bashes President Obama for cutting Medicare in order to pay for ObamaCare. For one thing, Obama modeled his health care overhaul on Romney's, but didn't have the option of simply handing the bill off to a larger governmental entity. Romney took money from the feds; Obama took money from Medicare. For another, any reform of Medicare to make it "sustainable" will necessarily require cutting it back from current projections.

Romney argued last night that he's a management turnaround artist who can undo the damage he says President Obama's done to the economy. But with RomneyCare, what the former governor has demonstrated is that he knows how to pass unexpectedly expensive health programs, hand their costs off to others, and then use slippery budgeting claims to hide their true price tag. He may be running against Obama, but he resembles the president more than he differs.