A Romney Victory Would Imperil Romney’s Greatest Achievement | TPMDC Quote: Like the Affordable Care Act, Romney’s Massachusetts law relies on adequate federal funding to provide subsidies, and an individual mandate — to pull younger, healthier people into the insurance risk pool and hold premiums down. Romney’s promised reforms as President — specifically his support for deep cuts to Medicaid and his call to allow individuals to purchase insurance across state lines — threaten that foundation.
Gruber agrees with this analysis.
“There are no subsidies in this market, so young healthies would have every incentive to exit,” he said. “We could end up back where we were before the mandate — a market that just has old and sick [people paying] incredibly high prices.”
Quote: But John McDonough, a Harvard health policy expert and another architect of Romney’s Massachusetts law takes a less grim view.
“It would depend on how such a law was written and how it would affect all state insurance mandates, not just those in Massachusetts,” he wrote in an email. “An individual who purchased a policy across state lines would still be legally subject to the requirements of the MA health reform law with it’s ‘minimum creditable coverage’ requirements … unless the ‘states’ rights’ supporting President Romney and Congress chose to override such state requirements and prerogatives.”
Absent an explicit pre-emption, he suspects that the Commonwealth Choice system would survive — because, he noted, allowing the sale of insurance across state lines “is the silliest and most uninformed health policy idea I’ve seen in about 30 years. Just dumb.”
He illustrated with a hypothetical.
“OK, I can buy a health insurance policy from Blue Cross Blue Shield of Alabama, lucky me!” he writes. “But with what providers in Massachusetts does BCB of A have contracts to pay for services? None.