Former Massachusetts Gov. Mitt Romney appears to be headed into the 2012 GOP presidential primary season as the consistent, if not overwhelming, favorite for his party's nomination.
But there remains great discomfort among a wide swath of party members over the striking similarity of the Massachusetts health care reform legislation Romney signed in 2006 as governor, and the federal health care overhaul President Obama put his signature on last year.
While Romney has alternately distanced himself from and taken credit for the Bay State law, his role in what former opponent Tim Pawlenty called "Obamneycare" could be a major obstacle to winning the GOP nomination.
The Massachusetts plan includes the requirement that individuals purchase insurance — which is also the most controversial aspect of the federal legislation. Legal challenges to its constitutionality are expected to ultimately be decided by the U.S. Supreme Court.
According to research from PolitiFact and the Kaiser Family Foundation, here are five other ways the two plans are similar — and five ways they are different.
- Both have individual mandates that impose a tax penalty on people who have the financial ability to buy insurance but don't. Federal penalties start at $695 annually, or 2.5 percent of income, whichever is higher. In Massachusetts, penalties range from $228 to $1,212, depending on family size and income.
- Both require health care "exchanges" (in Massachusetts, the exchange is called the "connector") designed to create a competitive health insurance market that gives individual and small business consumers a choice of private plans, rules that facilitate price comparison and plan transparency.
- Both leave intact employer-provided insurance systems — Medicare plans for the nation's seniors, and Medicaid for poor and low-income citizens.
- Both would fine companies that don't offer employee heath insurance, with exceptions for small businesses. Massachusetts requires companies with more than 10 employees to offer insurance; the national law sets the limit at 50 employees.
- Both provide subsidies to low-income individuals and families to help pay for health insurance coverage.
- The federal plan has a stated goal of attempting to lower health care costs; Massachusetts had no such stated goal.
- The federal plan includes a patients' bill of rights, and provisions designed to promote public health.
- The federal plan includes the so-called CLASS Act, a voluntary insurance program offered to workers for long-term care in the event that they become disabled when they get older. (The Obama administration last week delayed the program's rollout because it isn't financially self-sustaining as designed.)
- The federal plan would expand Medicaid to cover poor, able-bodied adults who are not parents in addition to poor children, elderly, pregnant women and those with disabilities. The Massachusetts plan expands Medicaid coverage to more children.
- To pay for the new coverage, the federal plan imposes taxes on a variety of sectors, from drug and medical device makers to health insurers. Massachusetts relies largely on federal matching funds.