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For months, Forbes contributor, Manhattan Institute fellow and former Mitt Romney health care advisor Avik Roy has been waging a one-man disinformation campaign against the Affordable Care Act. Now, after enduring a thorough beat down over his warnings about a looming Obamacare "rate shock," Roy is back to proclaim "Romney's Revenge." The former Governor, Roy insists, was right to claim during the 2012 presidential campaign that his signature Massachusetts health care law wasn't necessarily suited to other states because "our plan was a state solution to a state problem."

Of course, there are only a few problems with Roy's revisionist history. For starters, Romneycare wasn't a "state solution," but instead depended on the federal government to pick up half the cost of the Medicaid expansion Governor Romney required. More embarrassing for Roy, before Romney ran away from his health care law in order to win over conservative GOP primary voters, he proclaimed "Massachusetts is a model for getting everybody insured." And on that point, Americans are learning--much to Roy's dismay--that Romneycare largely succeeded. Call it "Romney's Boomerang."

But you'd never know that reading Roy in the National Review:

During the 2012 presidential campaign, Mitt Romney maintained that the health-reform law he signed in Massachusetts was not the same as Obamacare. "Our plan was a state solution to a state problem," Governor Romney insisted. He was trying to fix Massachusetts' uniquely broken insurance market, he said; Obamacare, by contrast, was "a power grab . . . a one-size-fits-all plan." Nobody took him seriously -- not conservatives, and not liberals. But today, as the nation braces for health insurance "rate shock," Romney's critique of Obamacare is ringing true. Call it Mitt Romney's revenge.
Given his staggering deceptions-per-word ratio, it's hard to know where to begin in deconstructing Roy's mythology. One place to start is with Mitt Romney's own words. As he explained to Sanjay Gupta of CNN in October 2009:
"Massachusetts is a model for getting everybody insured in a way that doesn't break the bank, doesn't put the government in the driver's seat and allows people to own their own insurance policies and not to have to worry about losing coverage. That's what Massachusetts did."
As it turns out, Mitt Romney didn't just boast that Massachusetts was a model for the nation; heacknowledged that his health care reform law simply would not have been possible without federal funds from Washington. As he described Romneycare to Bill O'Reilly in 2010:
"[F]rom the beginning the plan was a 50/50 deal between the federal government and the state government. The Feds fund half of it, they have from the very beginning." The Boston Globe notes that "approximately 56 percent of the gain in coverage was related to increased federal Medicaid support" in Massachusetts, and of the newly insured, "18 percent gained coverage through Medicaid, and another 38 percent gained coverage through Commonwealth Care, a program that federal Medicaid dollars pay half of."
That's why, as the Boston Globe reported in May 2012, President Romney "would probably cripple the Massachusetts health care law" Governor Romney birthed:

"It would have been impossible for Massachusetts to do what it did without increased federal Medicaid support,'' said John McDonough, a major architect of the state's health care overhaul law and now director of Harvard University's Center for Public Health Leadership. "What he's proposing is in direct opposition to what he did as governor,'' said Amy Whitcomb Slemmer, executive director of Health Care for All in Massachusetts, citing the Bay State's 98 percent coverage rate, the highest in the nation. "That kind of expansion would not have been possible under a block grant program,'' as Romney has proposed. Block grants give states more flexibility in spending federal money, but restrict funding increases.
So much for Romney's repeated protests that his health care program "solved a problem in the state with a state answer" and "didn't have the federal government come in and intrude on the rights of states." (In his book No Apology, Romney explained, "There were some big differences -- in particular, our plan did not include a public insurance option," a claim he dropped from the paperback edition.)   And so much for Roy's declarations that the "health-reform law he signed in Massachusetts was not the same as Obamacare." MIT professor and Obamacare/Romneycare designer Jonathan Gruber explained the difference between Romney's own Boston bill and the Affordable Care Act:
"Zero difference," he said. "This is, to my mind, the most blatantly obvious case of politics trumping policy I've ever seen in my life...Because they're the same f--king bill. He just can't have his cake and eat it too. Basically, you know, it's the same bill. He can try to draw distinctions and stuff, but he's just lying. The only big difference is he didn't have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes."
Raise taxes, that is, so that the roughly 15 percent of people without insurance--overwhelmingly residents of the reddest of red states--could obtain insurance.

Now in Avik Roy's defense, it is true that Massachusetts was unique in many respects. Prior to Romneycare, the state was already spending $1 billion annually to compensate hospitals for the cost of caring for the uninsured. The Bay State also already a low rate of uninsured residents (around 10 percent) before the Romney mandate kicked in. Thanks to the Bay State's already right regulation of the insurance market, Massachusetts residents did not experience sharp increases in premiums. (That's why, as even Roy acknowledges states like Oregon, New York, Washington and Colorado generally won't see significant premium hikes for individuals under the ACA.)  But in deeming "by its own standard [of cost control], Romneycare was a failure," Roy completely ignores the success of the program in delivering near-universal coverage. As I noted previously:

Enjoying the consistent support of Bay State residents by a 2 to 1 margin, the bill Governor Mitt Romney signed into law lowered the uninsured rate from around 10 percent to a national low of two percent [...] And as it turns out, only 48,000 Bay State residents out of a population 6.6 million opted to pay the penalty ranging from $228 to $1,212 a year rather than acquire health insurance under Mitt Romney's version of the individual mandate. That's less than half the national rate projected by the CBO.
Earlier this month, the Massachusetts Medical Society released survey findings showing continued strong support for the 2006 law signed by Republican Governor Mitt Romney, one its architect Jonathan Gruber described as "the same f**king bill" as Obamacare:
The survey finds that 84 percent of Bay State residents are satisfied with their health coverage -- considerably higher than the approximately 67 percent of Americans nationally who are happy with their health care. Specifically, respondents praised high quality of care and good access to medical services as the reasons for their satisfaction. An additional 75 percent said that finding the kind of medical care they need isn't difficult.

Those results track with earlier polls on Massachusetts' reform law. In 2011, a survey administered by state insurance officials found that 86 percent of residents were pleased with the range of services covered by plans under the law's insurance marketplace and 82 percent were pleased with their choice of doctors.

As it turns out, Obamacare isn't even a "one size fits all" plan. States can invest more in outreach programs and in subsidizing their insurance exchanges. They can opt-out of creating their own exchanges and, thanks to the Supreme Court, the expansion of Medicaid made possible by the ACA. And while some residents of some low regulation states may experience Avik Roy's dreaded "rate shock," millions more in Republican-led states will experience the real shock of being unable to get insurance at all, unlike their family and friends living in blue states.

Blue states, that is, like Mitt Romney's Massachusetts.

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