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Mitt Romney, Powerpoint Man

Mitt Romney is just wrapping up his speech right now. The short version is that he refused to apologize what he did in Massachusetts, but vowed not to impose it on the rest of the country.

He was in full consultant mode, complete with a powerpoint presentation. And his analysis of the dysfunctions of health care was excellent. I could have given parts of this speech. He even praised the French health care system--or, at least, elements of it.

But his efforts to distinguish Romneycare from Obamacare was weak, except where it was misleading. Sometimes it seemed as if the only difference between the two was the fact that the former had the word "Romney" attached to it, instead of "Obama." 

I will make one, quick substantive point. Romney says his first move as president would be to issue an executive order, “paving the way for Obamacare waivers for all fifty states.” Wondering what that means? I was too. So I asked Washington and Lee Professor Timothy Jost, who probably knows the legal specifics of the Affordable Care Act better than any other person on the planet. Here's what he told me: 

There is explicit provision in the ACA for waivers with respect to annual limits (on a temporary basis) and for adjustments on a state by state basis in the individual market for medical loss ratios. There is also long standing authority under section 1115 of the Social Security Act to permit waivers to accommodate Medicaid demonstration projects, some of which, such as the Arizona program, have turned into long term changes. There is no general waiver authority with respect to the issues you raise until 2017. The executive generally has some discretion in enforcing the law, and the admini stration has used this discretion in delaying rulemaking with respect to certain parts of the law (the provision prohibiting discrimination in insurance coverage on behalf of highly-compensated employees, for example), but across the board waivers would raise serious constitutional questions, particularly since the ACA makes explicit provision for such waivers but only under specific circumstances. It is up to Congress to change laws through constitutional processes.

Translation: The law gives the president and the secretary of Health and Human Services some leeway to exempt states from the Affordable Care Act’s requirements. But that leeway is very specific to certain parts of the law. Neither the president nor HHS can let states avoid setting up a basic health reform infrastructure, with regulations and subsidies, at least until 2017. And even then states can change their health care systems only insofar as they provide roughly equal insurance coverage, or better, at no added cost to the federal government.

States still have a lot of flexibility, particularly when it comes to desigining their insurance exchanges. But a President Romney couldn’t let them out of the law altogether, unless he persuaded Congress to go along with him.

I'll have more to say soon enough. Meantime, via Time's Swampland, here are Romney's slides.