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Massachusetts health care — wonky, with a healthy dose of reality

What Santorum Means

What Santorum Means

January 30, 2012

This exchange from last Thursday's Florida Republican debate was the most extensive discussion of health care so far in the primary season:
http://www.youtube.com/watch?v=kkC7WnxQccM

Romney gave a cogent, articulate defense of Massachusetts health reform (which of course goes just as well for national health reform under the ACA). Romney offered his standard defense of the individual mandate as reducing the number of "free riders" - "[I]f you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn’t have insurance, then we have to care for them in the hospitals, give them free care. So we said, no more, no more free riders.”

But Santorum responded with something that had a lot of us scratching our heads:

SANTORUM:So what is happening in Massachusetts, the people that Governor Romney said he wanted to go after, the people that were free-riding, free ridership has gone up five-fold in Massachusetts. Five times the rate it was before. Why? Because…
ROMNEY: That’s total, complete…
SANTORUM: I’ll be happy to give you the study. Five times the rate it has gone up. Why? Because people are ready to pay a cheaper fine and then be able to sign up to insurance, which are now guaranteed under Romneycare, than pay high cost insurance, which is what has happened as a result of Romneycare.
ROMNEY: First of all, it’s not worth getting angry about. Secondly, 98 percent of the people have insurance. And so the idea that more people are free-riding the system is simply impossible. Half of those people got insurance on their own. Others got help in buying the insurance.

After the debate, policy analysts and fact checkers agreed that Santorum didn't know what he was talking about. The Washington Post's Wonkblog explained it well:

Here’s one reason we don’t hear much about free-riding in discussions of Massachusetts health reform: It’s barely happening. About 0.6 percent of Bay State adults under 65 paid a fine for not carrying health insurance in 2009, the most recent year for which data are available from the Massachusetts Department of Revenue. That was back when 96 percent of the population had health insurance, a number that has since risen (as Romney pointed out last night) to 98 percent. The number of free riders would presumably drop as coverage increases, although we’re still waiting for data on 2010 numbers.

But a few days later, the Santorum campaign clarified what he was referring to. Santorum's "free riders" are different than the "free riders" that most people worry about. He was harking back to the DOI actuarial study (pdf) comparing 2006 and 2008 figures for people buying individual coverage and dropping it within 6 months. The numbers did almost jump five-fold.

Whether or not these people were free riders, in any case it's not a problem in Massachusetts anymore. Two years ago, the legislature enacted legislation setting up annual enrollment periods for individual coverage. We've been critical of some of the details of how this provision is implemented, but this issue that Santorum raised is no longer a concern here.

So groups like FactCheck.org amended their original call, that Santorum was completely wrong, to just point out that he's behind the times.
-Brian Rosman