ROBERT SIEGEL, host:
Former Massachusetts Governor Mitt Romney has a health care problem. It's his signature on a 2006 Massachusetts law that looks an awful lot like the federal health care law most Republicans now want to repeal.
Yesterday, the likely presidential candidate gave a speech in Michigan, and with it, Romney tried to draw distinctions between the state law that he says he still supports and the federal law he doesn't.
NPR health policy correspondent Julie Rovner reports on whether or not he succeeded.
JULIE ROVNER: One thing just about everyone agrees on: Mitt Romney doesn't have an easy task reconciling his views on health care. On the one hand, he says he still supports the Massachusetts law he signed five years ago, including its requirement that every state resident have health insurance.
Mr. MITT ROMNEY (Former Republican Governor, Massachusetts): I in fact did what I believed was right for the people of my state.
ROVNER: But at the same time, he says he opposes the federal law that was based, almost line for line, on the Massachusetts model.
Mr. ROMNEY: I believe it's an economic nightmare.
ROVNER: So instead, Romney wants to repeal the federal law and basically turn most of the responsibility for health care back to the states.
Dave Kendall, of the centrist Democratic think tank Third Way, says those things don't exactly go together.
Mr. DAVE KENDALL (Third Way): The Romney plan is a mass of contradictions.
ROVNER: For starters, Romney's biggest criticism about the federal law has to do with how it's financed.
Mr. ROMNEY: Under Obamacare, taxes are raised by about $500 billion over 10 years. We, of course, didn't raise taxes.
ROVNER: That's true. But what Romney doesn't say is that Massachusetts didn't have to raise taxes because the federal government paid much of the bill for the Massachusetts law.
The state had about a billion dollars in federal funding it was going to lose if it didn't pass its overhaul bill. As a result, says Kendall...
Mr. KENDALL: The federal government had to increase its deficit spending so that the Massachusetts residents didn't have to pay for that portion of the coverage.
ROVNER: MIT economist Jonathan Gruber, who worked on both the development of the Massachusetts law and the federal health law, says Romney's new proposals are also self-contradictory. For example, while Romney says he wants to give states more power to regulate health care, he also wants to let people purchase health insurance from states other than their own.
Mr. JONATHAN GRUBER (Economist, Massachusetts Institute of Technology): If people buy health insurance across state lines, then it eviscerates the ability of states to regulate their insurance markets because people who don't like the regulations can just buy elsewhere. So you can't have an effective system of people buying health insurance across state lines without imposing national regulations, totally inconsistent.
ROVNER: Romney said he's also confident that states can do a better job taking care of the poor if the federal government stops telling them how to run their Medicaid programs and turns the health program for the poor into a block grant instead.
Mr. ROMNEY: the idea that we would ever say to people: tough luck, you're poor, you're not going to have health care - that's just not American.
ROVNER: But Gruber wonders whether Romney has read reports from the Congressional Budget Office and other nonpartisan outlets that show how much turning Medicaid into a block grant would actually cut the program's funding.
Mr. GRUBER: You can't say we'll just cut Medicaid by two-thirds and figure it'll be OK. I mean, you're going to have to kick people off or dramatically reduce coverage.
ROVNER: So far it's not just Democrats who aren't impressed with Romney's efforts to remake his position on health care. Most Republican editorials and bloggers today said he didn't do himself any favors, either.
Julie Rovner, NPR News, Washington Transcript provided by NPR, Copyright NPR.