Remember Tim Pawlenty, the corn-pone-ish ex–Minnesota governor who surely wishes he hadn’t dropped out of the presidential race when he did? Remember his coinage “Obamneycare,” which he used in debates starting last June? Of course you remember. And if you don’t, I would expect and hope that this fall, the Obama campaign will start reminding you, because a moment in Thursday night’s debate brought into stark relief just how the issue of health care—which on paper ought to be an absolutely galvanizing issue for conservative voters this November—could instead damage for Mitt Romney this fall.
The moment was, of course, the exchange between Rick Santorum and Romney when Santorum was aggressively challenging Romney about health care. Romney was going through his standard defense of his health-care plan, saying it was right for Massachusetts but not for other states. Santorum wasn’t buying it: “Think about what that means going up against Barack Obama ... You are going to claim [about the Affordable Care Act], ‘Well, it doesn’t work and we should repeal.’ And he’s going to say, ‘Wait a minute, governor. You said it works well in Massachusetts.’ Folks—we can’t give this issue away in this election. It is about fundamental freedom ... It’s going to be on your ballot as to whether there should be a government mandate here in Florida. According to Governor Romney, that’s OK.”
That broadside forced Romney to go a step or two further in defense of his plan than he usually prefers to go. He went on, for example, about how the bill dramatically reduced the number of uninsured in his state, which it indeed has. But that sentence is a walking advertisement for the argument that the Affordable Care Act is going to succeed in doing exactly the same thing once it kicks in come 2014.
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For the purposes of how this plays out in debates this fall, there are two issues here: first, that of substantive difference between the bills, and second, what I’ll call states’ rights.
On the substance, there is virtually no difference between the bills. Well, OK, there are two differences. No. 1 is that Romney did not vastly expand Medicaid in constructing his bill. No. 2 is that Romney did not raise taxes to pay for his bill. Now, both of those differences sound like they reflect very well on Romney—he didn’t expand a big-government program that most people associate with poor folks and therefore do not like, and he didn’t raise taxes.
But why didn’t his bill do either of those things? It didn’t expand Medicaid, because governors have no right to expand Medicaid. And he didn’t raise taxes because—ready?—the federal government paid for about half of it ($385 million, largely in Medicaid money). And the federal government paid for about half of it largely because of the efforts of ... Teddy Kennedy, Romney’s great ally in putting the bill through. Jon Gruber, the Massachusetts Institute of Technology health economist who worked on Romney’s bill, has said, with only slight exaggeration: “They’re the same fucking bill. He [Romney] just can’t have his cake and eat it too. He can try to draw distinctions and stuff, but he’s just lying. The only big difference is he didn’t have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes.”
That takes care of that. But now we have this states’ rights question. This is a pretty slick defense on Romney’s part and reasonably effective, at least to GOP audiences. Conservatives love states’ rights, and even though they surely suspect that deep down Romney is lying or, at best, grasping at the nearest and handiest life preserver, they’re willing to give him a pass on this. In addition to the line about what’s good for state A maybe not flying in state B, Romney has also been making a legal distinction between his law and Obama’s: he has argued that states can mandate that individuals do or buy certain things, but the federal government cannot. The first point is true, but we don’t yet know whether the second point is; the Supreme Court will tell us later this year.
If the court upholds the Affordable Care Act, Romney’s argument is in tatters. If the court strikes down the mandate, Romney’s legal distinction holds true, but he would still face the potential skepticism of conservatives who’ve argued that just because something is legal doesn’t make it right (see, for example, this New Hampshire Union Leader editorial whacking him on this point).
So how would this play out in the general-election campaign, assuming Romney is the nominee? It would still be awfully hard for Obama to gain a health-care advantage; of the universe of people voting on health care, I’m sure more will be voting against him than for him. But Romney as the nominee means that the issue can be neutralized. “Governor,” the president can say, “if you’re going around bragging about how many Bay Staters your plan ensured, how in the world can you criticize my plan, which will do exactly the same thing? And don’t give us that you-didn’t-raise-taxes line. The only reason you didn’t is that you didn’t have to, because your friend and mine, Ted Kennedy, got the funding wired in Washington.” Et cetera. Romney’s vows to repeal the Affordable Care Act could end up sounding pretty hollow.
So Santorum was right Thursday night. Nominating Romney is giving up the issue, especially if the Supreme Court upholds the mandate. Obama probably can’t win the argument, but if his campaign handles the issue artfully, he can plant doubts in conservative and swing voters’ minds about Romney’s actual beliefs on the matter, which will play strongly into what presumably will be a key Obama theme of Romney as the say-anything candidate. Obama should even use Pawlenty’s little portmanteau. After all, it’ll be no loss to him if voters think of the plans as similar; making conservatives gnash their teeth is the point.
