Obama invokes the ghost of Mitt Romney

In their first face-to-face meeting since the third and final presidential debate, Mitt Romney joined President Obama for a private lunch at the White House to discuss America's leadership in the world. Tara Mergener reports.

This post originally appeared in National Journal.

BOSTON Defensive and deluged by skepticism and criticism, President Obama on Wednesday brought his battered health care law to one of the Bay State's best-known turnaround artists.

Mitt Romney.

Not that Obama's vanquished 2012 rival will be here for the pep rally. The White House didn't invite Romney, and he probably wouldn't have come even if offered a lift on Air Force One. Aboard that plane, White House spokesman Josh Earnest said that "successful implementation of health care reform in Massachusetts is an aspect of Governor Romney's legacy that he should justifiably be proud of."

So Romney will be a disembodied reminder that Obamacare can be saved from its feckless HealthCare.gov website debut, its underwhelming number of actual enrollees (most right now are in Medicaid, not private insurance), and outrage among those in the individual insurance market who now have to switch their policies after believing Obama when he said they could keep them. For his part, Romney said in a statement that success here was due in part to "carefully phasing ... in" the most cumbersome and economically disruptive parts of the law.

Romney, you see, turned the Massachusetts health care law around. At its launch, the law had several problems. One was collecting affordable premium bids for minimum insurance coverage and forced insurers to come up with lower-cost alternatives (resulting in average monthly premiums of $175 per month versus the initial estimates of $380 per month).

The plan also had tiny early-enrollment numbers and garbled regulations. Some parts of the law (subsidies for low-income recipients at or slightly above the poverty line and unsubsidized small-business coverage) had to be delayed for proper implementation. Over time, enrollment numbers came in, regulations were unsnarled, and public satisfaction in 2012 reached 62 percent.

Obama will say the Massachusetts law got off to an uninspiring start but everything eventually worked out.

Michael Dukakis had his Massachusetts Miracle. Obama has a Massachusetts Muddle.

"Your law was the model for the nation's law," Obama said in his speech Wednesday. "This new [national insurance] marketplace was built on the Massachusetts model."

Obama added he was "not happy about" the balky federal health care website. "We're going to get these problems resolved. Those plans are waiting."

Except health care costs did not decline in Massachusetts, and neither did medical-related bankruptcies--stated goals of both Romneycare and Obamacare.

More telling, Obama will have to argue that Massachusetts matters because complicated things are hard and problems arise. Fine. But that also betrays a harsh truth: The administration apparently learned nothing about the front-end political and policy hazards that Massachusetts confronted, or the gradualism required to implement the law. That means it was willfully ignorant of or indifferent to the anticipated difficulties of taking a compulsory state-insurance program nationwide. In the medical community, this has a name: malpractice.

The biggest problem for Obama now is the chasm between his promise to Americans that Obamacare would allow them to keep their individual-insurance policy and the reality of cancellation notices for millions in this market.

It's a complex topic, and the White House is practically begging for "context" to dilute the wrath of Americans who bought coverage, liked it, and thought they could keep it. There is no clarion of political distress louder or clearer than the plaintive cry for "context."

In this pursuit, I spoke with David Simas, one of Obama's top health care advisers, about this disconnect.

When the president said, as recently as March, if you have your plan and you like your plan, you can keep your plan, was he meaning unless your insurance company changes it?

Here's the perspective on the insurance market: 80, 15, and 5. Eighty percent of Americans have their coverage either at work, in Medicaid, or in Medicare, and so the Affordable Care Act just enhances their benefit. Fifteen percent of people are uninsured, and they get the new benefits of the Affordable Care Act. What we're talking about, Major, are those 5 percent of people who are in the individual market.

Roughly 14 million Americans.

Between 11 and 14 million Americans in what has been commonly referred to prior to the ACA as the Wild West of insurance marketing, and that was the case because if folks had preexisting conditions, they could be denied; if you were a woman, you could be charged double.... So what the Affordable Care Act did that was very clear was that it grandfathered plans.

So those plans came in as-is.

At that time, right. Here's what happened from that point forward: If there is a person who was on that plan when the law passed, there's been no change to the plan, they have stayed in it, that plan doesn't change, there's nothing different about that plan.

Now, if you left the plan and went into a new plan that came online after the Affordable Care Act, there are a whole bunch of new benefits and protections that apply to it. If your insurance company after the fact started making changes to the plan--as had been the case prior to the Affordable Care Act when people could be dropped, their premiums increased, or they could be underwritten--then those plans need to have the new minimum benefit protections that the Affordable Care Act had in place.

At the end of the day, what the Affordable Care Act did, which was significant and is significant, is going to be for those 11 to 14 million people who have been underwritten. One in five people who even applied for coverage on the individual market were denied because of a preexisting condition; one out of two people under 65 were subject to discrimination in terms of preexisting conditions; women were charged more; if you were older, what are called the rating bans were pretty excessive. All of that goes away.

Part of your effort to eradicate what you call the Wild West.

That's exactly right.

And the long arm of the federal government is required to eradicate that Wild West.

Well, look, it's not in terms of a long arm of the federal government, it's about certain basic consumer protections that people should expect. When you sign on for a plan, it's clear what you're receiving. The moment you get sick, you're not dropped. If you think that you're going to have coverage, all of a sudden you don't see fine print that says, "Oh, I'm sorry, but we only cover the first $500,000 of coverage."

For the Americans who have received these notices and it says here's a policy that's more expensive than the one you had, and they sit at their kitchen table and say "I heard the president tell me I could keep this plan, now I can't," you tell them what? "Blame your insurer" or "blame Obamacare?"

Prior to the passage of the Affordable Care Act, people like that family were getting that letter year in and year out but then didn't have any recourse. Here's the recourse that they have today: First, they have competition and choice, they can look at that letter from their insurance company or they can look for alternatives. Second, they can get tax credits that they didn't have before that drive down the cost of their insurance. Third, if they're a woman, they're no longer subject to double premiums, and the same thing with senior citizens.

They can find all that out on the website, once the website starts working better.

They can go to HealthCare.gov, they can go to the 1-800 number, they can go in person to one of the folks in our community health centers and navigators, they can go to their own state, [such as] Covered California, if they happen to live in one of the state-based marketplaces. Here's the bottom line: It's a six-month open-enrollment period, and those individuals now have some choice, competition, better coverage, [and] minimum consumer protections.

But for the sticker shock [of higher premiums] they should blame the insurance company, not Obamacare?

In terms of sticker shock, here's the thing that each and every family needs to see first: Am I eligible for tax credits? Second, is there a different insurance company that's offering me a better rate? For the overwhelming percentage of people on the individual market, who are going to be receiving letters like this that move them into new coverage, that's going to be the facts on the ground for them.

* * *

Obama is groping awkwardly for Romney's "facts on the ground" here. But that's a one-trick pony, a theatrical placeholder designed to buy time and counterbalance Health and Human Services Secretary Kathleen Sebelius's website apologia.

The true facts on the ground are shaking public confidence--already brittle--in Obamacare's many promises. The individual market story will have many turns, but the early reviews are decidedly negative, and if enrollment numbers don't measure up, Obama will wish his biggest problem was a balky website.

In his windup here in Boston on Wednesday afternoon, Obama said he will never give up on implementing the law. "We will grind this out. We will see this through. One and inseparable." That's two parts truth and one part silly sentimentality. The only thing inseparable from Obamacare is entrenched hostility. Obama has known that from the start. And that's made the grinding more difficult than it should have been. Anyone here could have told him that.