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Standing beside Republican presidential candidate Mitt Romney, Gov. Chris Christie had three strong words to describe any comparisons between Romney’s health care reform in Massachusetts and the national health care reform law:
"Completely, intellectually dishonest."
A week after ruling out his own candidacy, Christie on Tuesday traveled to New Hampshire to endorse Romney, the former Massachusetts governor. During a press conference, the discussion turned to the two health care reform measures.
"Any attempt to try to compare what happened in Massachusetts and what the president has done to the United States of America with his plan is completely, intellectually dishonest," Christie said. "Governor Romney did not raise one tax in doing what he did in trying to improve the health care system in Massachusetts."
Here’s what PolitiFact New Jersey found: Christie is right that Romney’s plan did not raise taxes, but there are too many similarities between the two reforms to dismiss any comparisons as "completely, intellectually dishonest."
First, let’s talk taxes.
Enacted in March 2010, the federal law imposed taxes on drug manufacturers, health insurers, medical devices and indoor tanning services, among other tax increases. The Massachusetts law signed by Romney in 2006 did not enact taxes, but was primarily financed through federal dollars.
"It’s a lot easier to not raise taxes if you have the federal government paying a large share of the tab when you’re a state," said Alan Weil, the executive director of the National Academy for State Health Policy.
Also, in 2008 -- after Romney left office -- Massachusetts raised the cigarette tax and imposed additional fees on private companies to help finance health-care costs.
Michael Widmer, president of the Massachusetts Taxpayers Foundation, said though the tax increases weren’t part of the initial health care law, they did help fund it. So, he said, "it’s not fair to say there’s no taxes raised."
Like the federal law, the Massachusetts law imposes a fine on individuals who do not purchase health insurance. Some experts argued that such a penalty is a tax.
"It’s government collecting money that you owe through your taxes," said Michael Doonan, executive director of the Massachusetts Health Policy Forum. "I would consider this a tax."
But Ed Haislmaier, a senior research fellow in health policy studies at the conservative Heritage Foundation, said, "In both the Massachusetts reform and Obamacare, the individual mandate is not a tax, but a penalty enforced through the tax system."
Still, the national health care reform was based on the Massachusetts plan, and the two have much in common.
The core elements of the Massachusetts law include the "same essential design" as the national health care reform, according to John McDonough, a professor of public health practice at the Harvard University School of Public Health.
"Regardless of the tax issue, to suggest then that there is no basis to compare the two sets of reforms is not valid," McDonough, who was involved in the passage and implementation of the Massachusetts law, said in an email.
Here are a few examples of the similarities between the two reforms:
Individual mandate: At the heart of both measures is the requirement that residents have health insurance, with exemptions for certain individuals. Otherwise, residents could face a tax penalty.
Employer requirements: The Massachusetts law requires employers with at least 11 full-time workers to contribute toward health insurance coverage, or pay a penalty per employee. Under the federal law, if employers with at least 50 full-time employees don’t provide coverage, they must pay a fee to cover the cost of tax credits used by their workers to purchase insurance.
Medicaid expansion: Both measures expand Medicaid in different ways. The national health care reform expands Medicaid to all non-Medicare eligible individuals under 65 years old who meet certain income requirements. In Massachusetts, the state’s Medicaid program was expanded to cover children with family incomes up to 300 percent of the federal poverty level.
Insurance exchanges: Both measures establish insurance exchanges where individuals and small businesses can purchase insurance.
"All of the basic elements are really, frankly quite similar," said Sarah Iselin, president of the Blue Cross Blue Shield of Massachusetts Foundation.
Christie dismissed comparisons between the federal health care law and the Massachusetts health insurance reform as "completely, intellectually dishonest," saying the state plan "did not raise one tax."
The state reform did not include tax increases, but it includes several core elements similar to those in the national reform. To deny that those similarities exist would be dishonest.
We rate the statement Mostly False.
To comment on this ruling, go to NJ.com.
Press conference with Gov. Chris Christie and Republican presidential candidate Mitt Romney, Oct. 11, 2011
PolitiFact, RomneyCare & ObamaCare: Can you tell the difference?, May 18, 2011
PolitiFact, Krugman calls Senate health care bill similar to law in Massachusetts, Feb. 4, 2010
PolitiFact, Obama says Heritage Foundation is source of health exchange idea, April 1, 2010
PolitiFact, Pawlenty says Obamacare is patterned after Romneycare, Aug. 12, 2011
The 2006 Massachusetts Health Care Reform Law: Progress and Challenges After One Year of Implementation, May 2007
Blue Cross Blue Shield of Massachusetts Foundation, Health Reform in Massachusetts Expanding Access to Health Insurance Coverage: Assessing the Results, April 2011
The Henry J. Kaiser Family Foundation, Massachusetts Health Care Reform: Three Years Later, September 2009
The Henry J. Kaiser Family Foundation, Focus on Health Reform: Summary of New Health Reform Law, April 15, 2011
2006 Massachusetts health care reform law
Center for Health Law and Economics, University of Massachusetts Medical School, Re-forming Reform: What the Patient Protection and Affordable Care Act Means for Massachusetts, June 21, 2010
Blue Cross Blue Shield of Massachusetts Foundation, Lessons from the Implementation of Massachusets Health Reform, March 2011
Health Connector: Health Insurance for Massachusetts Residents, Health Care Reform: Overview, accessed Oct. 12, 2011
Interview with Michael Doonan, Massachusetts Health Policy Forum, Oct. 12, 2011
Email interview with Sabrina Corlette, Georgetown University Health Policy Institute, Oct. 12, 2011
Email interview with John McDonough, Harvard School of Public Health, Oct. 12, 2011
Email interview with Nancy Turnbull, Harvard School of Public Health, Oct. 12, 2011
Interview with Michael J. Widmer, president of Massachusetts Taxpayers Foundation, Oct. 12, 2011
Massachusetts Health Connector and Department of Revenue, Data on the Individual Mandate: Tax Year 2008, December 2010
The New England Journal of Medicine, Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs, June 26, 2008
Governor of Massachusetts, An Act Making Appropriations for the Fiscal Year 2008 to Provide for Supplementing Certain Existing Appropriations and for Certain Other Activities and Projects, accessed Oct. 12, 2011
Email interview with Ed Haislmaier, a senior fellow in health policy studies at the Heritage Foundation, Oct. 12, 2011
Interview with Alan Weil, the executive director of the National Academy for State Health Policy,Oct. 12, 2011
Email interview with Daniel Bertrand, spokesman for the Massachusetts Department of Revenue, Oct. 12, 2011
Interview with Sarah Iselin, president of theBlue Cross Blue Shield of Massachusetts Foundation, Oct. 12, 2011
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