Look to Minnesota, Pawlenty says. There, he boasts, he was able to reform the health care system “the right way.”
This is code in the GOP for “no individual mandate.” Back when even some conservatives supported the idea, Romney’s plan included a mandate. But then it served as a model for the Obama administration’s own health care reforms, and thus has become a huge liability for him in the primary — particularly the mandate.
But Pawlenty’s plan isn’t much beloved on the right either. And for all his allusions to his plan’s success, it didn’t do anything to reduce the ranks of the uninsured in his state. In fact, they went up.
Pawlenty enacted some health care delivery reforms in Minnesota, which are projected to save the state money. But his signature initiative — the “Smart-Buy Alliance” required no legislation.
The plan, as described by the Commonwealth Fund, linked government, big employers, and unions, to essentially create a prudent purchaser pool. The alliance — which provided insurance to the majority of the state — doesn’t pay for health care services directly. They still rely on private insurers. But, on behalf of state and private-sector employees, they use considerable buying power to influence the price and quality of the product those insurers sell.
Those are fine reforms — but they did (and do) nothing to address the fact that some employers don’t offer insurance, or that some people are unemployed, or self-employed, and can’t afford insurance on their own.
Indeed, by any measure, according to the Minnesota Department of Health, the rate of uninsured during Pawlenty’s tenure went up notably. In 2004, the state had a 7.7 percent rate of uninsurance (low by national standards). By 2009, that had climbed to 9.0 percent.
In Massachusetts, by contrast, Romney began his term with a similar uninsurance rate. Now it’s below two percent, almost entirely attributable to RomneyCare.
So when GOP candidates blast Romney for the mandate, that’s the record they’re criticizing.
Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. He can be reached at firstname.lastname@example.org.