AMES, Iowa - Mitt Romney offered an enthusiastic defense last night of the comprehensive health care law he helped create four years ago in Massachusetts, even as he pointed to crucial distinctions between it and a similar national program enacted last week by Democrats.
"Overall, ours is a model that works," Romney said in response to a question after a speech at Iowa State University. "We solved our problem at the state level. Like it or not, it was a state solution. Why is it that President Obama is stepping in and saying `one size fits all' "?
Obama's signing of a federal health care law has put Romney - a possible 2012 presidential candidate - again on the defensive over the most significant achievement in his brief career in public office. The former governor, who has been mentioned as a possible candidate again for president in 2012, had labeled Obama's bill "unhealthy for America" and has called for its repeal, even as conservative critics say it was modeled on Romney's policy.
Yesterday, Romney proudly acknowledged that his bill included a set of new insurance regulations that "President Obama always likes to talk about in his health care plan - the good stuff." Romney trumpeted the achievement of near-universal coverage in Massachusetts, while declining to acknowledge that the mechanism he used to achieve that goal - a requirement that individuals buy private insurance - is the same as the much-criticized mandate of Obama's plan.
The accounting of "some similarities" and "some differences" between the two systems was a more delicate comparison than Romney has offered recently, when he wholly rejected the idea that the two had anything significant in common.
"People often compare his plan to the Massachusetts plan," Romney said in an interview last month. "They're as different as night and day. There are some words that sound the same, but our plan is based on states solving our issues; his is based on a one-size-fits-all plan."
In the last week, many health care policy specialists, Democrats celebrating the bill's passage, and Republicans condemning it have come to another conclusion. The difference between the two systems, they say, is slim.
"Basically, it's the same thing," said Jonathan Gruber, an MIT economist who advised the Romney and Obama administrations on their health insurance programs. A national health overhaul would not have happened if Mitt Romney had not made "the decision in 2005 to go for it. He is in many ways the intellectual father of national health reform."
After Congress last week passed the national plan, considered the most expansive social legislation to become law in nearly a half-century, Romney wrote it was an "unconscionable abuse of power" that "will create a new entitlement even as the ones we already have are bankrupt." Romney's political action committee, a leading supporter of Republican candidates nationwide, has begun a campaign to support those who voted no as part of what it calls a "Prescription to Repeal."
Romney says he will not decide whether to run again until after the midterm congressional elections in November. Yesterday, his national tour promoting his best-selling book, "No Apology," returned him to the early-caucus state of Iowa for his first solo events there since he ended his 2008 campaign, and reinserted Romney's health care views into the context of presidential politics.
"His problem is not to get demagogued that the Obama bill and his bill are the same thing," said Mike Murphy, a Republican strategist who helped to direct Romney's gubernatorial campaign. "The question for Mitt is, if he runs: Can he keep his own health care identity - his brand - and not let his opponents suck him into a false label?"
Governor Tim Pawlenty of Minnesota, the most active of Romney's potential presidential rivals, has repeatedly invoked Romney's bill unfavorably as a precedent for Obama's. "Looking at the Massachusetts experience, it would not be one I would want for the country to follow any further," Pawlenty told the Nashua Telegraph this past weekend.
Romney faced a similar predicament during his last presidential run, when opponents attempted, with various degrees of success, to portray his record in Massachusetts as evidence of liberal priorities. Over the course of his campaign, Romney went from touting his health care policy to lamenting it to saying it was not really his, often at a disorienting pace.
State legislators had made changes to the bill over his veto, Romney said, even though when he signed the law he called it "exactly what we'd hoped for." Regardless, he argued during his campaign, he believed that the Massachusetts plan would not necessarily work everywhere and that states should be free to follow their own strategies.
Romney, who finished second at the Iowa caucuses in 2008, spent much of that campaign working to distance himself from Massachusetts' political culture. Yet the farther Romney gets from his State House service, the more he finds himself having to discuss the details of his tenure.
"I don't pretend for a minute that our system is perfect," Romney said of the Massachusetts plan. "I think it's better than what we had, and I think people can learn from what we have done, and I think there are changes I would make to it."
In his book, Romney describes a personal awakening on the issue of health insurance that has led him to share many of the assumptions underpinning the Obama plan. Both programs declare universal coverage as a goal, requiring individuals to purchase their own coverage and offering subsidies to those unable to afford it. That strategy sets him apart from many national Republican leaders, who rarely cite universal coverage as an objective and who have backed a lawsuit by state attorneys general asserting that the individual mandate is unconstitutional.
"I'm not at all surprised to think I have differing views on some topics than my fellow Republicans," said Romney. "I think it's very important to get everybody insured."
In Ames, Romney said he opposed new taxes levied by Obama and cuts to the Medicare Advantage program, which he described as fiscally reckless while noting the Massachusetts plan required no new funding. Gruber said Romney's criticism was "disingenuous," given that the state already had revenue committed to emergency medical care.
Republican strategists predicted that as the 2012 primaries approach, conservative critics would probably continue describing "Romneycare" and "Obamacare" as sister initiatives. Romney will have to explain why the distinction between a state-level plan and a federal one is philosophical and not only technical, they said.
"He's going to need to say exactly why the bill he signed in Massachusetts is different and better than Obamacare," said Jon Seaton, a Republican consultant who ran Senator John McCain's 2008 Iowa caucus campaign.
"He's going to need to answer the question if this issue is still as hot then as it is now."