In one of the most contentious exchanges among the candidates at Tuesday night's GOP presidential debate in Las Vegas, former Senator Rick Santorum lashed out at former Governor Mitt Romney's Massachusetts health care reform program as a budget-busting model for the Obama administration's health care plan. Romney insisted he never suggested it should be a model for the rest of the country, and maintained it remains popular in his home state.
"I was asked, 'Is this something that you would have the whole nation do?' And I said no this is something that was crafted for Massachusetts. It would be wrong to adopt this as a nation. "
-- Former Massachusetts Gov. Mitt Romney
"You've blown a hole in the budget up there, and you've authored in Obamacare which is going to blow a hole in the budget of this country. "
-- Former Senator Rick Santorum, R-Pennsylvania
"The people of Massachusetts like it by about a 3 to one margin. " -- Former Massachusetts Gov. Mitt Romney
The Facts: In his book published in 2010, Romney writes about his Massachusetts health care reform plan passed in 2006, "My own preference would be to let each state fashion its own program to meet the distinct needs of its citizens. States could follow the Massachusetts model if they choose, or they could develop plans of their own. These plans, tested in the state 'laboratories of democracy' could be evaluated, compared, improved upon, and adopted by others. But the creation of a national plan is the direction in which Washington is currently moving. If a national approach is ultimately adopted, we should permit individuals to purchase insurance from companies in other states in order to expand choice and competition.
"What we accomplished surprised us: 440,000 people who previously had no health insurance became insured, many paying their own way. We made it possible for each newly insured person to have better care, and ultimately healthier and longer lives. From now on, no one in Massachusetts has to worry about losing his or her health insurance if there is a job change or a loss in income; everyone is insured and pays only what he or she can afford. It's portable, affordable health insurance - something people have been talking about for decades. We can accomplish the same thing for everyone in the country, and it can be done without letting government take over health care."
The verdict: True, but incomplete
As for Rick Santorum's assertion that Romney's plan has "blown an hole" in the Massachusetts budget, the New England Journal of Medicine carried out an extensive analysis of the costs in 2009, concluding that "the only responsible way to address this question is to assess the new burden on state taxpayers by examining the net new costs to the state's general fund." The Journal states, "Before reform, the state provided about $1.4 billion annually in subsidies to institutions to cover services for the uninsured, about $33 million of which came out of the general fund. After reform, with revenues redirected to support Commonwealth Care subsidies and expansions of MassHealth (the Massachusetts Medicaid program), a decrease in spending on the uncompensated care pool, and a phasing out of subsidies for managed-care organizations associated with safety-net institutions, the net new spending was $591 million, of which $172 million - less than 1% of the state budget - came from the state's general fund."
The Journal also notes that "a recent report showed that employers, government, and individuals pay approximately the same proportion of health coverage costs after reform as they did before reform."
The verdict: False
And what about Romney's claim that people in his home state favor the plan by a 3-to-1 margin? A poll conducted by the Harvard School of Public Health and The Boston Globe earlier this year found 63 percent of Massachusetts residents support the 2006 health care law. That's up 10 points in the past two years.
The verdict: True