In 2012 Preview, Pawlenty Takes Aim at RomneyCare

In today's Washington Post, Tim Pawlenty has an op-ed urging Washington to learn from health care reform experiences at the state level. Not surprisingly, he touts reform efforts in Minnesota, but it's also noteworthy that he takes aim at the Massachusetts overhaul that was led by Mitt Romney (though he doesn't mention Romney by name). Not that Pawlenty is a free market puritan on health care -- he supported SCHIP, for example -- but the disastrous results of Romney's health care plan in Massachusetts could prove a big obstacle for him during the 2012 Republican primaries in which at the moment, he's viewed as the very early frontrunner.

Romney has tried to have it both ways on health care. On the one hand, he points to health care as an example of his ability as an executive to get things done, yet at the same time he blames the Democratic legislature for changing his original plan (even though he signed it with changes, knowing that he wouldn't be around to oversee its implementation and that his successor would likely be a Democrat). He wants to take credit for the fact that his plan expanded coverage, but doesn't want to accept blame for the endless wait times for doctors, skyrocketing costs and the fiscal crisis that went along with that expanded coverage. He claims that his plan is a free market alternative to a government takeover of health care, and yet it's a plan that expanded Medicaid rolls, forced individuals to purchase insurance or pay a tax, and had government provide subsidies to people to purchase a government-run insurance on a government-run exchange. Anybody worried about life under ObamaCare should not be a fan of RomneyCare -- other than the absence of a government plan in the exchange, both plans are structurally very similar.

By Philip Klein on 8.3.09 @ 10:20AM

Replicating Massachusetts’ Health Reform on a National Level

Massachusetts’ innovative approach to health care reform, adopted in 2006, has become the focus of substantial national attention as Congress and the Administration in Washington focus intense attention on health reform. Many federal proposals build on elements that have been implemented in Massachusetts. Two questions are of interest in this regard: can the federal government adopt the Massachusetts approach, and, failing federal reform, can Massachusetts serve as a model for other States?

For background, the key elements of the Massachusetts program can be summarized very generally as follows: An individual mandate requiring most residents to have insurance; assessments on certain employers who do not make adequate insurance available to their employees; a “health care connector” that links individuals and small businesses to insurance products; and State-subsidized insurance for persons who are not eligible for Medicaid with incomes up to 300% of the Federal poverty level (the “CommonwealthCare” program).

The individual mandate is key to achieving near universal coverage, and other components of the reform facilitate access to “affordable” coverage. The reform’s approach is to move uninsured people into insured status, and to reduce reliance by safety net hospitals on disproportionate share and supplemental Medicaid payments by providing them an insured population in lieu of uninsured individuals.

Many of these elements appear in the various federal proposals, including the individual mandate, the connector and imposing some form of assessment on employers. As to other elements of federal proposals, Massachusetts does not include a public plan option, although CommonwealthCare could be viewed as a workable alternative.

However, in creating the coalition that secured passage of the reform, political and policy leaders deliberately chose to address access first and defer dealing with how the program would be paid for. This of course is not an option for the federal government, which is struggling with how reform will be funded.

Massachusetts could defer the cost issue because the amount of new State dollars needed at the outset was relatively small. This was so because of: (a) CMS’ willingness to grant a waiver allowing federal Medicaid matching funds for the CommonwealthCare subsidies; (b) the generous level of State dollars that was already flowing into the health care system through Medicaid and the State’s uncompensated care pool; and (c) the relatively larger number of large and small business that already provided some coverage for their employees.

Of course, the economy and serious budget problems are now affecting CommonwealthCare’s financing. This year for the first time there will be some restrictions on who can enroll, and some adjustments to available benefits. Massachusetts did try to address health care cost through legislation in 2008, but the focus was more on long-term structural changes, such as incentives to promote more primary care physicians (one of the downsides of improving access in Massachusetts was to make worse an already bad situation of too few primary care physicians), supporting the greater use of nurse practitioners and effectively mandating that hospitals and physicians move toward adoption of electronic medical records and CPOE systems. The legislation, however, is not generating immediate cost savings.

In summary, Massachusetts’ program has many elements that could work at the federal level and could be adapted for use in other States. Two critical points need to be kept in mind, however: First, the creation of a coalition that included Government (including a Republican Governor and an overwhelmingly Democratic legislature), consumer advocates, employers and insurers and the willingness of each of the groups to compromise (an individual mandate balanced against some employer assessments, for example) got the reform enacted but is not easy to replicate.

Second, as noted above, financing could be deferred because the marginal dollars needed to fund the reform initially were not so great. (Shortly after enactment of Massachusetts’ reform, a California study concluded that implementing the same program there would cost that State an additional $12 billion.) The key issue for the federal government is how to fund reforms. Massachusetts may be a good model but the particular financial circumstances that existed when its reform was enacted may make the model difficult to replicate elsewhere.

Stephen M. Weiner, Esq serves as President of the national nonprofit HealthWell Foundation (www.healthwellfoundation.org), which provides financial assistance to underinsured patients coping with serious and chronic conditions. He is also Chair of the Health Law practice for Mintz Levin and has over thirty years of health care experience as a policy maker, educator and attorney.

Source: Physician News Digest

There are many better options out there that do not include:

• a public option that will lead to a single payer socialized medicine
• rationing
• duty to die aspects for seniors
• forced mandates for all physicians to perform abortions
• government being involved in what should be doctor-patient decisions
• a national database giving government access to everyone’s health records

What we need is

• regulation and over-sight by the government… of Insurance Companies, Big Pharma, the AMA and no more
• overhaul of Medicare, Medicaid, Veteran’s Health, Indian Reservation Health (government has done a terrible job with these programs… and that should speak for itself)
• tort reform
• allow companies and individuals to go across state lines to purchase insurance
• allow individuals and and small business to form co-ops to purchase insurance.
• portable health insurance
• attention and a stop to fraud in all the government-run programs and by the insurance companies and Big Pharma
• no more exclusion by insurance companies of people who have pre-existing conditions.

Source: True Health Is True Wealth

Related Resources:

• Safeway’s Health Care Program Gets Attention
• Kristol: Kill It, And Start Over

Posted: Daily Thought Pad

Minn. Gov. Pawlenty Says He's Focused on GOP, Not 2012

ST. PAUL, Minn. -- Minnesota Gov. Tim Pawlenty is a man on the move. Next stop, the Republican National Committee meeting in California. Future stop? Maybe the White House.

The two-term fiscal and social conservative is taking necessary steps toward a possible presidential bid — headlining GOP fundraisers, taking an influential job at the Republican Governors Association, mulling his own political action committee.

But Pawlenty says he's focused on the party, not 2012.

"Anybody who is out focusing on (2012) instead of working toward getting the party moving forward or back in a better position in 2010 is really doing us a disservice," Pawlenty told The Associated Press.

However, his track record of GOP building in Minnesota is less than stellar. Republicans have lost ground in every election since he became governor in 2003. He is the sole statewide GOP officeholder and his party controls its fewest legislative seats since 1992. Pawlenty himself narrowly survived a three-way election contest to win his second term. But the governor said that's not his fault.

Minnesota is "probably one of the most liberal states in the country," he said. "When the pendulum swung back to the left, we were at a tenuous point to begin with."

At age 48, with almost two decades of state government service under his belt, Pawlenty denies looking very far down the national road. But he's getting the early exposure he'll need if he formally joins a GOP field that could include better-known former governors like Mitt Romney, Sarah Palin, and Mike Huckabee.

He has assumed the No. 2 post at the Republican Governors Association, a perch that will involve steering assistance to GOP candidates in close races. And he's jumped into the national healthcare debate, criticizing President Barack Obama's plan in a way also seen as a veiled swipe at potential rival Romney. (He labeled a Massachusetts overhaul enacted under Romney an "experiment" with a swelling price tag.)

Pawlenty also told the AP he's considering forming a political action committee — a staple that gives potential presidential candidates a way to raise money and organize travel to election battlegrounds.

Pawlenty's recent travel has taken him to Washington, Arkansas, and Colorado. But he hasn't yet ventured to presidential proving grounds Iowa or New Hampshire and wouldn't say when he would. He visited both while campaigning for 2008 nominee John McCain — who considered him for the running mate slot Palin got — but still has plenty of work to do.

Republican John Finnegan, 50, of Concord, said Wednesday he had heard Pawlenty's name but not much else.

"I don't know anything about the guy," he said.

In Iowa, Sioux City businessman and former state GOP chairman Ray Hoffman rated Pawlenty as merely a possibility. "Would I put him at the top of the list? At this point, no," Hoffman said.

At least one Iowa conservative group, the American Future Fund, has invited him to speak. Organizer Tim Albrecht said Iowa Republicans are eager to hear from their neighboring governor firsthand, but understand why he hasn't come yet.

"The biggest risk in coming to Iowa too early is it can seem overeager or ambitious to talk about 2012," Albrecht said. "It is a delicate balance, a tightrope they need to walk in order to be successful."

But Republican strategist Terry Nelson, who managed McCain's early campaign efforts, said potential candidates' groundwork must be laid to move quickly after the 2010 election.

"Really, candidates have to decide that in the next 18 months because it's not the kind of thing anymore you can decide in June or July of 2011," Nelson said.

Republican national committeewoman Phyllis Woods of New Hampshire plans to ask Pawlenty to visit her state when she sees him in California. Woods said she met Pawlenty during last summer's GOP convention in the Twin Cities and considers him a "feet-on-the-ground, good, solid, conservative Republican."

"I would like to learn more about him," she said.

Woods and representatives from all 50 states will get their chance at Pawlenty's speech Thursday.

Pawlenty tends to stick a formula at the podium: He'll begin with a self-deprecating joke — usually about a comment by his wife or two daughters — and connect the punch line to a broader point of his speech.

The son of a truck driver, he's also fond of talking about "Sam's Club Republicans," potential GOP voters with blue-collar backgrounds who want leaders to apply customer values to government. Lately, Pawlenty has shared a tough-love message with Republican audiences, saying his party will keep "losing market share to our competitors" until it finds a better, more inspiring message.

Whether Pawlenty can break through to sustain a 2012 campaign is hard to say.

Drake University politics professor Dennis Goldford said a northern governor must find a way to appeal to an increasingly southern GOP base. He needs to weave a message attractive both to people who want to make the party more pure and to those seeking centrist remodeling.

"At this point you just don't know the political terrain," Goldford said. "All you can do right now is introduce yourself and put yourself in people's vision and mind and then say 'I'll be back.'"

© 2009 Associated Press

Romney picked as 2012 GOP front-runner at CPAC

WASHINGTON (CNN) -- Conservative activists on Saturday named former Massachusetts Gov. Mitt Romney the winner of a poll for best 2012 GOP presidential candidate.

Former Massachusetts Gov. Mitt Romney won 20 percent of the vote in straw poll for presidential favorites.

 

 

The poll marked the third consecutive year Romney came out on top.

Louisiana Gov. Bobby Jindal placed second in the annual poll, conducted at the Conservative Political Action Conference.

Romney received 20 percent of the vote and Jindal got 14 percent.

Close behind were Texas Rep. Ron Paul and Alaska Gov. Sarah Palin, who each received 13 percent of the vote.

The results were culled over two days from 1,757 of the party activists who came to Washington for the annual conference and filled out ballots on Thursday and Friday. Nearly 60 percent of the straw poll participants were between the ages of 18 and 25. More than half of the conference attendees this year were college students.

The choices in the poll were: Florida Gov. Charlie Crist; former House speaker Newt Gingrich; former New York City mayor Rudy Giuliani; former Arkansas Gov. Mike Huckabee; Jindal; Paul; Palin; Minnesota Gov. Tim Pawlenty  ; Romney; South Carolina Gov. Mark Sanford, and "Undecided." There was also space on the ballot for a write-in candidate.

The results could go a long way in shoring up a presidential hopeful's conservative resume, as was the case with Romney when he won the straw poll in 2007 for 2008.

The eventual Republican nominee, Sen. John McCain, finished fifth in the 2007 vote, and lost to Romney in 2008 as conservatives at the conference expressed frustration that the Senate maverick was close to cinching up the nomination.

On Friday, Romney and Gingrich packed the ballroom.

Texas Rep. Ron Paul also drew a big crowd and lots of applause. Paul said the conservative movement has struggled to define what it means to be a conservative.

In criticizing Obama and House Democrats in a speech Friday, Romney -- often interrupted by standing ovations -- made clear that he intends to remain a player in Republican politics as he eyes a potential presidential bid in 2012.

CPAC attendees also were able to vote on their approval of President Obama and Republicans in Congress.

Only 4 percent said they approve of the job Obama is doing.

CPAC ended Saturday with radio talk show host Rush Limbaugh delivering the keynote address.

Limbaugh called on conservatives to take the country back.

"I want to tell you who conservatives are. We conservatives have not done a good enough job of just laying out basically who we are because we make the mistake of assuming that people know," he said.

"We love people. When we look out over the United States of America, when we're anywhere, when we see a group of people such as this or anywhere, we see Americans."

In order to take the country back, Limbaugh said, "All we need is to nominate the right candidate. It's no more complicated than that."

Limbaugh praised Obama as one of the most gifted politicans he has seen, but said, "It just breaks my heart that he does not use these extraordinary talents and gifts to motivate and inspire the American people to be the best they can be. He's doing just the opposite."

Limbaugh accused Obama of wanting people to be in fear instead of motivating the country.

In the absence of a clear GOP leader, a political ad airing Friday put out by supporters of Obama implies the conservative radio host has himself become the de facto head of the Republican Party.

The ad argues that the Republican leadership in Congress is following Limbaugh's lead in opposing the Obama administration's $787 billion stimulus package.

"So who are Republican leaders listening to?," the announcer asks before the 30-second ad cuts abruptly to footage of Limbaugh saying, "I want him [Obama] to fail."

It was paid for by Americans United for Change and the American Federation of State, County and Municipal Employees (AFSCME) union, two groups that supported Obama during the election and are advocating for his agenda.

In response to the ad, the Republican National Committee said, "The Democrats are running a permanent campaign rather than doing the bipartisan work of governing."

"These ads are part of the Democrats' larger strategy to do something, anything, to try to take the focus off their massive spending binge," RNC spokesman Alex Conant said.

Meanwhile, throughout the conference, other Republican leaders and rising stars took turns at the podium.

Pawlenty told the conference audience Saturday that Republicans must do a better job of reaching out to working-class voters, a group he said agrees with the GOP on most issues, from gun rights to health care to education.

The problem, Pawlenty said, is that lower and middle income voters -- a group he terms "Sam's Club voters" -- don't believe Republicans "are for the working person."

He said the party must stress its commitment to job creation and market itself "with a feel and concern and tone and an understanding of the importance and the challenges of the working class of this country.

"And it doesn't mean we have to sacrifice our principles to do it," Pawlenty said.

Like most of the Republicans who have addressed the annual gathering of conservatives this week, Pawlenty characterized the White House economy recovery package as a "sprawling spending buffet."

The governor bemoaned the president's budget plan, unveiled earlier this week, which predicted a $1.75 trillion deficit for the upcoming fiscal year.

"A day or two later the Democrats convened a fiscal responsibility summit," he said. "What's next? Are they going to have Rod Blagojevich convene an ethics summit?"

Pawlenty and his wife Mary also spoke Friday night to a closed-door reception for "Rebuild the Party," a Web-based grassroots initiative to modernize the party.