Obama's speech in Boston this week sought to showcase the similarities between Obamacare and Romneycare. Photograph: Jason Reed/Reuters  President Obama parachuted into Boston this week to wax nostalgic about Massachusetts healthcare reform.  Flanked by his good friend Massachusetts Governor Deval Patrick and cheered by a friendly crowd (minus a few anti-Keystone XL pipeline hecklers), it was clear why the president felt "good to be back in Boston". Under siege after the disastrous website launch of his own national healthcare exchange, Obama hoped to boost the fortunes of his own signature achievement – for a few minutes in the news cycle at least – by showcasing some of its similarities to the country's first successful universal health care reform effort.  Let me give you the Massachusetts perspective.  Seven years ago then-Governor Mitt Romney, flanked by Democratic Senator Edward Kennedy and a phalanx of state lawmakers and other officials, signed the legislation that became the template for Obamacare. "Romneycare", like Obamacare, was built on "ideas about markets and competition that had long been championed by conservatives", said Obama who used the same downtown Boston venue, the historic Faneuil Hall, to make his pitch.  In a 2006 address, Romney called the state's healthcare law, which created a new marketplace where people could research and buy healthcare plans vetted by state officials, a "once in a generation opportunity". He said:  Let's open the way for every Massachusetts citizen to have high quality, private health insurance.  At that time, more than 500,000 people in Massachusetts were uninsured.  The Massachusetts healthcare law requires every resident to have health plan coverage; anyone who decides to forgo coverage must pay a penalty based on 50% of the minimum insurance premium available that an individual would qualify for. An independent public board, the Massachusetts Health Connector, oversees the healthcare exchange, which offers a range of insurance options from providers that have met the state's coverage standards.  The Bay State also expanded Medicaid subsidies for low-income residents and increased the numbers of children who are eligible. Young adults are allowed to stay on parents' plans until they turn 26, or they can seek out reduced rates for coverage through the state exchange. Massachusetts did not levy new taxes to pay for the program; higher Medicaid reimbursements from the federal government cover the programs costs.  Obamacare operates on a similar framework. The federal government expanded Medicaid eligibility. Young people can stay on their parents' plans until age 26, but it does the Bay State one better by allowing them to stay on that plan even if they have a job that offers insurance coverage.  Most Massachusetts residents accepted the individual mandate with few complaints. Businesses, however, balked at what turned out to be the most controversial aspect of Romneycare, a $295 per employee penalty for firms with 11 or more full time workers that choose not to offer insurance.  Obamacare is more forgiving of small businesses. Firms with less than 50 people do not have to pay a penalty. The federal plan comes with a sweetener that Romneycare did not offer: companies that meet certain criteria can receive tax credits.  A 2012 study by the Massachusetts Taxpayers Foundation, a statewide business group, found that only a tiny percentage of the state's budget went to Romneycare. However, the federal health care plan includes new taxes such as levies on medical devices and tanning salons.  Although Obama celebrated the state's bipartisan healthcare accomplishments, the Bay State's political realities were more complex than the optics at the Faneuil Hall signing suggested. Romney was well acquainted with the facts of the game in Massachusetts.  He weighed in at important junctures in the healthcare debate. But with an overwhelmingly Democratic legislature steering the bill from start to finish, the governor was essentially relegated to a secondary role. Romney vetoed the employer penalty, a symbolic rebuke many believed was predicated more on his presidential run than Massachusetts realities. The legislature had little trouble overriding his veto.  Romney knew that Massachusetts was onto something revolutionary, but fearful of conservative opposition on the road to the White House, he ditched those aspirations. When he became the Republicans standard-bearer in 2012, he abandoned the most important piece of legislation during his tenure in office.  Even as Obama trumpets the Massachusetts reform, it's far from a one-size-fits-all model. The Bay State is an outlier in the US, a comparatively wealthy state where many people were already covered by employer-sponsored health insurance programs. The number of uninsured people was small and a large number of residents were already eligible for Medicaid.  Today, 98% of state residents have health insurance coverage. An August Massachusetts Medical Society poll found that 84% of respondents were satisfied with their healthcare choices and experienced few problems finding care. As the president rightly pointed out, no "parade of horribles" descended on the state.  However, Romney weighed in the Bay State plan on that very subject on his Facebook page:  A plan crafted to fit the unique circumstances of a single state should not be grafted onto the entire country.  Universal health coverage in Massachusetts is settled business. State lawmakers, healthcare professionals, and economists are focused on trickier issues like controlling healthcare costs. It remains to be seen if the rest of America can embrace Obamacare's similar reforms without fear or begin to devise viable alternatives to cover the uninsured that are tailored to each individual state's circumstances.
Gabrielle Gurley: Obama touted the success of the Romney model this week. They're similar, but it's unclear if we'll see success nationally