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Romney Says He Cares. His Agenda Disagrees.

Mitt Romney has rediscovered Romneycare. Under attack for his apparent lack of empathy, Romney in an NBC News interview on Wednesday pointed to his Massachusetts health care reforms as proof that he cares about poor and low-income families:

Don’t forget, I got everybody in my state insured. One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record

For what it’s worth, I’ve always suspected Romney’s motive in Massachusetts had more to do with efficiency than social justice. He saw reform as a way to make the state’s health care system more rational and to make people accept more financial responsibility for their own medical care. Still, he deserves credit—and praise—for helping to design, promote, and then implement a law that has made health care more affordable for the people of Massachusetts. 

But in politics empathy isn’t simply about rhetoric. Its about policy. Here, again, is what Romney has proposed on health care.

1. Romney wants to repeal the Affordable Care Act, which would bring Massachusetts-style reforms to the rest of the country and make insurance available to almost everyone.

2. He wants to hand Medicaid over to the states and then, in short order, dramatically reduce its funding.

3. He wants to change the tax treatment of company health benefits, in ways that could make it less available even to middle-class people in the long run.

These three changes—repeal of Obamacare, the end of Medicaid as we know it, and changes to the tax code—represent nothing short of a wholesale revolution in health care. (“Repeal and Reverse,” as Ed Kilgore likes to call it.) The changes would arguably more sweeping than the ones Obamacare will cause. They would inarguably be more cruel.

How cruel? A brand new report from FamiliesUSA can give you some idea. Based on calculations by Jonathan Gruber, the MIT economist, by 2016 the number of people without health insurance would be 40 million higher than it would be if the Affordable Care Act went into effect. 

But even that figure understates the possible impact of Romney’s proposals. Remember, one way Obamacare makes health care more affordable is by providing tax credits to people who buy private insurance on their own. Romney has indicated previously that he’d replace that tax credit with a tax deduction, although now he says merely he wishes to “equalize” the tax treatment of employer and non-group insurance. If you assume, as Gruber did, that’s he’d stick with a deduction—and, if you take his overall spending plan seriously, he’s got no room for a generous credit—only people who pay income taxes would get federal assistance. And, as Mitt Romney reminded everybody at that Boca Raton fundraiser, 47 percent of all Americans don’t pay income taxes. As you can imagine, given their relatively lower incomes, they tend to be the people who need help the most.

Is the report trustworthy? FamiliesUSA is an advocacy group that supports health care reform. Gruber, whom I’ve known for years, is a well-known proponent of the Massachusetts model, which he helped craft, and the Affordable Care Act, for which he supplied technical projections. But Gruber’s numbers line up with previous estimates, based on the House Republican budget, from the Kaiser Family Foundation and Urban Institute. The numbers are also broadly consistent with findings from the Congressional Budget Office and, more generally, what we know about the types of plans that Romney has endorsed.

If you don’t believe me, listen to Larry Levitt, senior vice president at the scrupulously non-partisan Kaiser Family Foundation. Via email, he told me the national numbers in the Families USA report make sense, given what we know about Romney’s plans:

The Affordable Care Act, or what some refer to as ObamaCare, and proposals during the campaign from Governor Romney have very different aims. The health reform law provides significant financial relief to low and middle income families through tax credits and an expanded Medicaid program to reduce the number of Americans uninsured. Governor Romney proposes to give people who buy insurance on their own a tax deduction, which would provide much less assistance. And, transforming Medicaid to a block grant could result in shifting costs to states or fewer people covered. The plans would have very different effects on the number of Americans uninsured and how much assistance people get, befitting their different aims.<<

Romney supporters will undoubtedly claim the new report makes unfounded assumptions about his plan, since he hasn’t specified many of the details. (One Romney supporter made the case even before the new report came out.) But Gruber made several assumptions that were favorable to Romney. For example, Gruber assumed that states could find enough new efficiencies in Medicaid to provide the same coverage for 25 percent less funding. That’s almost certainly not the case. Medicaid already pays providers less than just about every other insurance program, including Medicare. I don’t know any serious health care expert who thinks states could absorb such a big cut without reducing either access or quality.

And, of course, what’s true of Romney’s health care plan is true of his spending plan overall. As I’ve said again and again, Romney’s pledge to cap non-defense federal spending at 16 percent of gross domestic product would require dramatic cuts to programs like Head Start and public housing vouchers—not to mention services on which the middle class also rely, like food and drug inspections. 

By the way, as Steve Benen points out, Romney gave the interview with NBC immediately after an event in which he blasted Obamacare. If Romney truly has empathy, he’s got a funny way of showing it.

Update: With a few changes for clarity and style, plus some new links. I also rewrote, twice, the passage about whether Romney wanted a deduction or a credit. Romney used to say one thing, now he says another, and it’s difficult to tell what he really wants. I’ve done my best to allow for that fact.

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