Source: Gibson, Dunn & Crutcher LLP.
Source: Gibson, Dunn & Crutcher LLP.

With President Barack Obama invoking Mitt Romney to defend the Patient Protection and Affordable Care Act this week in Boston, it’s worth considering what U.S. health-care policy would look like today if Romney had won the presidency a year ago. The answer: very different in many important ways, but frustratingly similar in others.

A Democratic Senate would probably have blocked efforts to repeal Obamacare, leaving Romney to halt or reverse the law through executive action. As promised, he would have found a way to issue waivers from Obamacare to states so that they could pursue their own health-care reforms.

But at the end of the day, Obamacare would still be the law, partisan gridlock would still cast its shadow over the policy-making process, and President Romney’s executive actions would be the source of myriad legal challenges from the law’s supporters.

Let’s consider each of these actions separately. First, thwarted by the Democratic-controlled Senate, Romney would have issued an executive order suspending the establishment of the Obamacare exchanges, freezing funding for implementation of the law and creating broad exemptions from the individual mandate.

He also would have suspended or rewritten any regulations issued by the Obama administration that had the potential to increase health insurance costs, displace patients from their existing health insurance coverage, or restrict choices for consumers.

Keeping Insurance

One benefit of this executive action would have been that no American would need to worry about losing their existing health insurance coverage. That’s because Romney would have reversed an Obama regulation that is forcing many Americans off their existing plans and onto new (and probably more expensive) plans that met the law’s requirements. This regulation strips protected status from a health plan that makes even routine changes, such as changing a yearly out-of-pocket maximum or tweaking co-pay amounts.

Second, using his executive authority to limit the law’s impact, Romney would have stuck to the core of his defense of the Massachusetts health-care reforms and his opposition to Obamacare: Each state should have the freedom and flexibility to pursue the health-care reforms that work best for its citizens. And the plan that works best in a state like Massachusetts is probably doomed to fail in a very different state or as part of a reform plan at the federal level.

This was ultimately what Romney found most offensive about the health-care law -- the imposition of a one-size-fits-all federal plan onto states that should instead have been empowered to explore their own health-care reforms.

As president, Romney would have used waivers from the law and other executive authority to give states the ability to pursue reforms that both expand coverage and lower costs. These waivers would, in many ways, strike at the heart of the law. And while this freedom and flexibility might result in some liberal states going as far as adopting single-payer systems, Romney believed that our federal system should encourage this kind of experimentation in health-care reform. The best models would succeed, while the worst ones would fail.

Finally, Romney would have recognized that while states should take the lead on reform, there were some federal reforms that were needed to improve on the pre-Obamacare status quo.

He often spoke of these reforms while campaigning: ensuring that individuals purchasing their own health insurance would receive the same tax benefit as people buying it through their employers, providing protections for those with pre-existing medical conditions, and lowering costs through the interstate purchase of health insurance and medical-liability reform. Romney’s priority would have been to address the continuing rise in health-care costs, as a predicate to expanding access to coverage.

Political Cover

Republicans don’t all agree on the need for these reforms, or on how they ought to be carried out. (There are, for example, some Republicans who do not believe that medical-liability reform should be carried out at the federal level.) That’s largely why Republican congressional leaders have preferred to focus their attention on repealing Obamacare -- where we broadly agree -- rather than on the disagreements that come with any effort to replace the law with new reforms. Even if Romney had become president, these internecine disagreements would probably have interfered with his ability to advance a coherent and unified package of reforms.

One year after the 2012 presidential election, and in the midst of Obamacare’s rocky implementation, it’s tempting for those of us who supported Romney to say “I told you so.” But it’s more important for us to find common-sense ways to work together to deal with a law that is so clearly broken.

That’s why President Obama’s speech this week in Boston was so disappointing. It wasn’t about apologizing for the law’s poor implementation, offering to work with Republicans to deal with its shortcomings, or even comparing Obamacare to Romney’s reforms. It was nothing more than an attempt to use Romney’s success in reforming health care in Massachusetts as political cover for staying the course on Obamacare. It was the clearest illustration yet of an administration trying to defend the entirety of a law that has become, in many ways, indefensible.

Things wouldn’t have been perfect had Romney been elected - - after all, Obamacare would probably still be the law. But at least our health-care system would be headed in the right direction and toward reforms that would lower costs, expand choices for patients, and allow those who were happy with their health-care plans to keep them. And those are results that Obamacare can’t deliver.

(Lanhee Chen is a Bloomberg View columnist and a research fellow at the Hoover Institution at Stanford University. He was the policy director of Mitt Romney’s 2012 presidential campaign. Follow him on Twitter at @lanheechen.)

To contact the writer of this article: Lanhee Chen at lchen301@bloomberg.net.

To contact the editor responsible for this article: Christopher Flavelle at cflavelle@bloomberg.net.