The Health Reform Paper Gov. Romney Doesn’t Want You to Read

We’ve been trying to get our hands on it for a long time, and in today’s Globe, Steve Bailey provides the first public look at the Health Reform White Paper prepared for Mitt Romney in May 2004 by his then-Health & Human Services Secretary Ron Preston. If you want to read the whole paper, click here (pdf). Now that’s transparency!

A little history. Way back in spring 2003, Romney told Preston he wanted a plan to cover everyone in MA with health insurance. Preston’s team worked with heavy hitter consultants from Mercer and Lewin and more. Always with two assumptions Romney shared: 1. The plan would cost a lot of new money. 2. The plan needed to require participation by all employers and individuals. In May 2004, Preston presented the White Paper to Romney to move the discussion forward, incorporating the two assumptions — $900 million plus in new money, plus employer and individual mandates.

In August, 2004 or thereabouts, Romney came to his senses (someone finally said to him: “Uh, Governor, if you embrace an employer mandate, you can kiss the White House goodbye.”) The Preston process was halted. Policy Advisor Tim Murphy was brought in to engineer a new plan with no new revenues, no employer mandate, and an individual mandate. The plan was to be released in early 2005. In November 2004, Senate Pres. Travaglini surprised everyone by announcing that he wanted to cut the number of uninsured in half within two years, getting big front page play in the Globe and elsewhere. Romney’s folks rushed to write an op-ed, printed a few days later in the Globe, calling for universal coverage — with details to come later. In spring 05, Preston announced he would leave his job in the summer, which he did, replaced by Murphy.

In November 2004, we filed a Freedom of Information Request with the Romney Administration to obtain health reform documents especially the Preston White Paper. They refused. Now it’s out.

As Bailey notes, the White Paper should be required reading for everyone involved in the health reform debate. For example:

– It debunks the notion that we can cover everyone without new revenue, and calls for about $951 million, mostly by hitting all employers who don’t cover their workers with a $150 per month head tax. Interesting, the Blue Cross Foundation Roadmap plan estimated that universal coverage would require about $900 million in new revenue. “To cover the uninsured, there must be new money to subsidize coverage…”

– It says all employers have to be part of the solution. “Most Massachusetts employers offer health insurance. … It is unfair to these businesses that their insurance costs are higher because other businesses do not do their part. … Levying a fee on employers who do not contribute to the cost of covering an employee discourages crowd-out, and injects a measure of fairness into the financing of health insurance.”

– It embraces the House health reform position that: “Every Massachusetts resident whose household income is at or below 100% FPL (federal poverty line) is eligible for MassHealth, regardless of U.S. citizenship status.” (At least someone in the Governor’s office must have lost their breakfast after reading that last clause.)

Let the conclusion speak for itself:

“As there is nothing new under the sun, there are no new ideas in this proposal. Rather, it is the combination of these ideas that is unusual, each keeping unlikely company with the others. The left wing, the right wing, and possibly everyone in between will be affronted by one or another feature. So will every interested party, be they administrators, clinicians, insurers, providers, suppliers, manufacturers, employers, employees, advocates or academics. On the other hand, all of these factions and parties will also find something to like.

“Health reform fails when people differ on their first choice, but agree on their second — that being to do nothing. We pursue health insurance for everyone, a benefit to everyone. We presume that to get there, everyone must pay some or give some, and most must do both.

“If our proposal goes anywhere, its elements will undoubtedly be heated, cooled, split and recombined. But our premise will stand. Everyone must pay some or give some, and most must do both. If we all do our parts, we can do this task. We will see everyone insured, and we will thereby lay a foundation for a better commonwealth and better health care for all.”

Sound like the health care consensus that might have been. And a good reading assignment for the Health Reform conferees.