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Schedule your free consultation at LASIK Plus today. Hey, it's Jonathan Cohn here at the Bull Work in front of the State House of Massachusetts on a pretty important day when they celebrated the 20th anniversary of the 2006 health care law. That's the reason that almost everybody in Massachusetts has health insurance and was the inspiration for the Affordable Care Act nationwide. They had a big event to celebrate it. One of the speakers was Mitt Romney, the governor who was instrumental in crafting and then signed the law. He sat down and let's talk about what made it possible how a conservative Republican businessman ended up across the table from liberal Democrats in one of the bluest states in America and how they found a way to get to a deal. And whether that kind of politics is still possible in America. And if not, what will take to get it back? Here's our conversation. My guest is former Senator Mitt Romney and former Governor Mitt Romney, former Governor of Massachusetts, which is where we are today. Very special reason for that. We are celebrating the 20th anniversary of the 2006 health care law, which you were instrumental in writing, passing. Of course, you signed it. Transformational legislation here, also widely seen as the sort of proof of concept, inspiration, prototype for the Affordable Care Act, for better or worse, depending on your opinion. I'm sure we'll get into that in a minute. But really what I was excited to talk to you about and what I hope you can spend time talking about is how the Massachusetts law came to be and how you, a conservative Republican governor, came to work with liberal Democrats in one of the bluest states in America to pass this law. I was at the event today this morning with a big celebration at Fanuel Hall. And I know this story, but what I always thought was fascinating. I mean, this is your signature accomplishment. I know the portrait of you has your wife's picture and the Massachusetts law on the desk. You didn't campaign on health care, right? It was that kind of, you know, and it was a business contact of yours who kind of brought it up to you. Yeah, I was on the board before I became governor of a company called Staples. I heard of it. I've heard of it. It's a company and the founder of that company was a guy named Tom Stenberg. Right. And he came into my office when I'd been governor for a few months and and he said, you know, Mitt, why'd you run for governor? And I said, Tom, you've heard my campaign speech. You know, I want to help people want to help people of our state. And he said, well, if you really want to help people, you'll get everybody health insurance. And it's like, I said, Tom, you can't you just can't get there. It would cost a fortune. You know, we can't it's not possible. He said, yeah, but if you really want to help people, you'll find a way. And that began to grind in my mind. And I began to wonder, well, what in the world can we do? And I began to look at some information. I asked my staff. Help me understand. I've heard about this. You're a PowerPoint guy. I've been told this by many people. Yes. You love a good PowerPoint. Yeah. Yeah. Well, I mean, I asked my team, my Secretary of Health and Human Services, as well as my legislative director, help me understand, you know, what's happening with health insurance for people here? How many people don't have insurance? What happens when someone without insurance gets sick, get a heart attack, and you don't have insurance? What happens? Well, they go to the hospital, they get treated. And I said, well, then who pays? Oh, well, actually, the state does. I said, what do you mean? So, well, we have a pool where every year we take hundreds of millions of dollars and we pay to the hospitals that are providing the disproportionate amount of care that's given for free. And the idea was pretty simple, which is let's take that money we're using to give people care that are sick, that we're giving to hospitals, and use it instead to help people buy their own insurance, to subsidize their purchase of insurance. And that was the idea. And then we began working through the numbers. And lo and behold, we said, you know, if we do this right, we can end up getting everybody in the state insured without having to spend more money, without having to raise taxes. That was the objective. And we got pretty darn close. I know that to make this happen, it wasn't just in the state. You had to get permission. You had to get a waiver from renewal from the federal government. And you had a partner in that. You ended up working with Senator Ted Kennedy. Now, a lot of our viewers made for too young. Remember, I was in Massachusetts when he ran against you for the Senate seat, or you ran against him in 1994. That was a bitter race. I mean, I remember, and you too, I mean, he's an icon of Democratic. I mean, he was then in the mailers, what like AOC is saying, he was the face you put on a mailer to raise Democratic money. And here you are, a Republican challenge. You know, so you guys were bitter foes once upon a time. Now, you guys are working together. How did that happen? I mean, well, we were friendly on a personal basis. We just had very different points of view about how to get things done, and what was the best thing you could do for people. But the idea of saying, you know what, we can get everybody insured and have people responsible for their own insurance. We can do that without raising taxes. That was kind of a hard idea to pass up. And for that to happen, you're right. We had to get Tommy Thompson, and then after that, Mike Leavitt, the two secretaries of HHS, to say, okay, we'll give you the waiver to use Medicaid dollars that are currently being given up for free care. We'll let you use those dollars to help people buy insurance. And so I called on the secretaries, took Ted Kennedy along with me, to make sure they knew this was bipartisan. And they were wise enough to realize that if... This is the Bush administration. This is the Bush administration. And they would have been happy just to see me, but they, I'm sure, but they had to realize to get it passed in a legislature in Massachusetts that was at that time almost 90% Democrat, that it had to be blessed by Ted Kennedy. And he saw our approach and said, you know, this could work. And we did some things that were a little controversial. One was, look, if you're a young person that's healthy, you got to have health insurance. We can't let you just sort of be out there driving your car, skiing, paragliding, and so forth. And if you get hurt, expecting everyone else to pick up the bill, you got to pay whatever it is, $1,000 a year, whatever it was at that time, to have some basic health care coverage. Everybody's got to be part of a pool. That's how health insurance works. And the concept flew with Ted Kennedy and ultimately did with Mike Levin and Tommy Thompson. There's a story I heard. Tell me this is urban legend that when you guys went to get the waiver from Tommy Thompson, it was former governor from Wisconsin, his HHS secretary was his last day in office. And there was a reception afterwards. And you and Senator Kennedy were telling jokes or were saying it. Was there some kind of reception or some... What was going on? It is true. As he was leaving, my recollection is that Senator Kennedy and I were there and toasting him and his service and expressing appreciation for the support that he was giving us and what we were There was some entertaining going on there. It's anywhere else. I wish I could tell. I really don't recall. See, we needed cell phones back then. Yeah, exactly right. So at the ceremony, we were at Fanwell Hall today. That's where you signed it. It was a big ceremony. Big production. I remember watching that and I remember rereading afterwards. Senator Kennedy's remarks was very clear. He was already thinking of this as a national model. And I will tell you, I remember interviewing former President Obama about the Affordable Care Act and opened up a question. Why did you think you could do healthcare? And he was one of the things right out of the day saying, we saw what they did in Massachusetts and we thought we could do something like that, both in terms of the policy, but also the kind of bringing people together, which didn't happen. We'll get to that in a second. Were you thinking when this was done that this could be a model for the rest of the country? I thought it could be a model for other states. And for the country, state by state. And I had members of my staff that said, look, it's working here for a couple of reasons that are important. One is we only have 7% uninsured. I think that was the number. Texas has like 20% uninsured. So what we did here and what Texas would need are going to be very, very different given the just the sheer numbers. Number two, we are paying money to hospitals that are giving out free care. So we're taking money we're already spending. We're already spending. And we're going to use it to help people buy insurance. So that maybe there's another state that's like that, but we don't know the other states terribly well. If it were to be done with the federal government doing it, it'd be very expensive. And you couldn't do some of the things that we did in the bill that I think made it more effective. We started providing data to people on the quality of different healthcare providers. We gave them a star system on their quality. We published the prices for various procedures. We said, these are things we think are important to do. Washington didn't pick up on that. So was it a model for other states? Yeah. Was it ready for a national implementation? Well, that was a little more fraught with a lot of difficulty, a lot of pushback. And there are things by the way, in the Massachusetts plan, I vetoed. Right. You vetoed the employer contribution. Yeah. I had a bunch of things. I didn't like, I mean, the litigator wanted very poor people not to have to pay anything. All right. I said, no, no, everyone has to pay something. It can't be free. You got to have people paying $100 a month, at least. Everybody's got to pay. Well, the litigator took that out. I vetoed it. They put it back in. Overrode by veto. So, I mean, I think you've got to make sure that you have the incentives aligned. And they were not perfect here, although net net, a positive. But the federal level, I think the incentives really got cockeyed. So you run for president. And I remember, I saw your speech in Michigan. I remember you gave a speech and you said, basically, what you just said to me now, which is you thought this was a good model for Massachusetts, not for the rest of the country. And you defended the mandate as you just did, as, you know. And again, people may forget this now. It was super controversial. Were you surprised how much within your own party, the mandate was sort of controversial and sort of your position was controversial? A little surprised, although I think in politics, maybe more today, even than them, which is if it's an idea raised by a Republican, Republicans like it, if it's idea raised by a Democrat, Republicans hate it. And vice versa. So the basic idea that people shouldn't get something free from government, that's kind of a Republican conservative approach. And that's what the plan said. Look, you can't just be a free rider. You can't be someone earning, in today's dollars, $100,000 a year and say, I'm not going to have insurance. And if I get sick, I'm going to go to the hospital and the government will pay. It strikes me as a Republican idea to say, if you can afford to buy insurance, you got to have insurance rather than showing up and expecting to get free care. And that strikes me as conservative and Republican. But as soon as Barack Obama started talking about this, Republicans, you know, ran for the exits. But I think it's a conservative approach to say, you got responsibility for yourself. So go forward to the 2017 Donald Trump gets elected. They have, they've tried to repeal very famously the vote fails in the Senate. Two of you know, you know, Lisa Murkowski, who I know you're still don't know if you're still close, but certainly more in the Senate. Susan Collins and John McCain very famously with the thumbs down. I was just curious if you'd been there, how would you have voted? You know, I don't know what the legislation looked like. So it's really hard for me to say. Did you have any impressions of the way it was being done or anything like that? I wasn't following it closely enough. I can't say I'd love there to be federal healthcare legislation with reforms, not just taking people off of rules. That's not reform. That's trying to save money, which by the way, doesn't save money. What we found in Massachusetts was if people don't have insurance, you still pay for them because they get sick to go to the hospital. You care for them. Someone's got to pay. And the if the hospitals pay for it, they then add it, they have to add it to the charges they provide to people who do have insurance. So it's like, wait, wait, people have to pay for them what they're getting themselves. So would I like to see federal legislation on healthcare? Absolutely. Do I have ideas? Yeah, they may not work very well. I'd like to see states try some ideas. I mean, this is a, for instance, you go to other countries, people own their own insurance. Their company doesn't own the insurance. Right now in America, the company provides you your insurance. If you change jobs, go to different companies, you change insurers. That means the insurance company has no particular incentive to try and keep people healthy because they know you're going to be going somewhere else. Their incentive is just to keep their cost down as much as they can and to deny coverage. But if instead people own the policy, they shopped and they own the policy all their life, or they could change if they wanted to, but they owned it mostly for their entire life. The insurance company now wants to keep them healthy. Give them incentive to keep them healthy because they know they're going to have them most likely for years. I mean, these are the kinds of things. Right. Now, I will say Bernie Sanders would say, you're right, just we should have the government do it instead of, you know, private insurance. I don't know anything the government does. And I'm trying to think of an exception and I can't think of one off the top of my head, but anything the government does, it's more efficient than the private sector. Right. Now, there's some things the private sector can't do. It can't do the military. But it's proven it can do the post office. Apparently, almost as good, if not better than the post office. But yeah, so I don't want the government to do it, but I'd like people, I'd like to try somewhere. People owning their own insurance and see whether... Experiment like you did in Massachusetts. Yeah. Let some stay, try it, and see if it made things better or worse. You served in the Senate. Bipartisanship there. How does it compare to what you experienced when you were in Massachusetts? How much of it is still that's... Can you do that kind of deal making anymore? Is that kind of constructive still possible? Or is it, you know, nowadays is not so much? Well, I think anybody who's running in a primary, who says that they want to go to Washington and work on a bipartisan basis, ought to be looking for a new job right away because they will not get elected. You want to run as a Republican, you're going to be beating up the Democrats and vice versa. It's all attack. The other guys are evil. You know, we've got to push back. We've got to fight. That's the rhetoric. And even going to Washington and working on a bipartisan basis is not something that's going to help you in your primary. And by the way, most senators only worry about their primary. Most congressmen, overwhelmingly, most congresspeople only worry about their primary. The general election in Utah, where I, you know, live, the general election is going to be for the Republican, no matter who it is. And so people worry about their primary. They want to make sure they're, you know, satisfying to the base of their respective parties. So bipartisanship is very hard to do. Well, what that means is with rare occurrences when you have a divided government in Washington, if you have unified government, as we have now, Biden had that for a while. Trump has it now with House of Senate and the White House. They want to do things through reconciliation, which gets around this bipartisan requirement in the Senate, the filibuster. So you're a fan of that you like the 60 votes. You want to get out? Got to have it. Don't have the 60 vote. I'll be, I'll be thinking about selling America short at that point because you, you go, I mean, it'd be great when Republicans are in charge. Right. But guess what? The Democrats someday be in charge and then everything would shift. You'd have tax policy swing from one to the other immigration policy swing. It would be a union policy. It would, we'd flip from one side of the other companies wouldn't know how to invest because they didn't know our Democrats going to take away the return on my investment or Republicans going to give it back. You have to have bipartisan buy in in order for people to have confidence that you're going to have stability and stability is essential for families and for investors. Forget everything you had planned for this weekend because you are sitting on your couch and winning from the comfort of your own home. I'm here with spin quest where you can play hundreds of slot games, all of the table games you love, and you could even win real cash prizes. New users $30 coin packs are on sale for 10 at spinquest.com. Spin Quest is a free to play social casino. Boydwear prohibited. Visit spinquest.com for more details. How much do you are? I mean, that's been feels like it's been an issue for the last year. I mean, we had a lot of volatility on, I mean, not just healthcare, but tariffs, all of that. I mean, as someone for the business background as well. I mean, are you worried about that? Well, tariffs and other things are our president tries to act unilaterally and Congress can agree or not agree, but they use typically reconciliation as a way to try and get something done. Biden did and Trump did as well. The big beautiful bill was done by the Trump administration on a reconciliation basis. There are narrow limits on what you can do through reconciliation, but they're going to push it as far as they possibly possibly can. That makes me uneasy, but at least it's there for the major policy changes such as those that we would have in healthcare. How much have you thought about the breakdown of bipartisanship? How much do you feel like that's a function of things like social media, the environment, and how much that a function of who's in charge of the parties right now? Yeah, I think a lot of it is the change nature of media, which is we become more divided, I think in part because of social media. People get their news curated for them by various social media sites and therefore don't get the same facts, don't understand the other side's point of view. And some people who we elect to go to Washington tend to not be in a bipartisan mode. At the same time, I think both with President Biden and with President Trump, they're appealing to their respective bases. And I mean, President Biden, when he said, look, we're going to forgive a trillion dollars of student debt, I mean, he knew that was not legal. He said that in the outset, but it appealed to his base and it infuriated a lot of people and upset a lot of young people who had student debt. They didn't know whether to pay it off or not. And they got whipsawed. It's just, but that's unfortunately the nature of what's happening in Washington today. That at some point, I believe will change. I was there for a glorious period when we had divided government, Republican House, Democrat Senate, Democrat White House, and we were able to work together with Susan Collins and Lisa Murkowski and John Tester and Joe Manchin and Mark Warner. People, both sides of the aisle came together and we fashioned many pieces of legislation that got passed on a bipartisan basis, in part because we had divided government. I mentioned before I live in Michigan now, which is where you grew up and your family is very famous there. Your father is a very famous governor of Michigan and was, I think, thought of as an archetype of a bipartisan, right? I mean, he was a conservative business Republican who had a good working relationship with unions and on civil rights. And very famously, I think you were there for this when he had the famous speech at the 1964 convention. And what do you think he would think about the Republican Party today? Well, he wouldn't recognize the party today. It's changed dramatically. It has moved on cultural issues as well as policy issues. I think, you know, I can't remember who I think was, Bill Clinton, who said it's the economy stupid. I think today it's the culture stupid. I think, I think by view as Democrats have staked out some positions or a number of Democrats have that don't make a lot of sense to everyday Americans. Defund the police. It's like, are you kidding? You think that's going to sell in cities? Defund the police? Biological males competing in girl sports? Like, that doesn't make any sense at all. Open borders? People flooding into the country? People saying, what in the world are you doing? Democrats were doing some absolutely, in my opinion, just crazy stuff. Right. And that cost a lot of everyday Americans to say, you know, I used to be a Democrat, but I can't put up with that stuff. And they became Republicans. And I mean, I think the Democratic Party is in a world of hurt in part because of their posture on so many of these social issues. And what about the Republican Party? Do you feel like where they are, I mean, do you feel like on immigration? I mean, there's a lot of policies where people would say, you know, they are extreme in their own way. And does that? Well, we're both parties are creating their own problems. I think what the president did to secure our border is wisely done and very popular. I think some of the ICE actions throughout Minnesota and other places as seen by people as being unnecessarily brutal and has hurt the president's popularity. So some things, I think the president has done that make a lot of sense that are politically attractive. Other things I think are more harmful. Look, I have a list of things where I agree with President Trump and it's a good long list. Then I have a list of things where I disagree with him, but I understand his logic and say, you know, he may be right. How may be wrong? I'm not right on everything. So, you know, here's some places I disagree. And then there's some things I go, holy cow, that just doesn't make any sense. I can't, I can't see some reason for it. And, you know, people will sort that through in their own mind and decide whether they want to support it going forward. But I think both parties have sewn the seeds of defeat in part by taking some positions which I think are out of the mainstream. Very last thing. Right when you announced you were retiring, you gave an interview where you said you were hopeful that your wing and the policy wing of the Republican Party was going to be resurgent. You still hopeful? A year and a half later? Well, obviously hopeful, but not optimistic. Not optimistic anytime soon. I mean, I, you know, I think Vice President Vance is very much in the, you know, footsteps of Donald Trump and will pursue that course if he's the nominee. I'm not sure about Marco Rubio. Maybe he would as well, but I don't see a big departure. Although with Vance and Rubio, who are kind of the leading contenders in people's minds, they're both really smart guys. And while I may disagree with them on a number of policy things, I don't think they'll make some of the mistakes that I think are harmful that are being made in our party today. All right, Senator, Governor Romney, thanks so much. Pleasure. Happy to be with you. Thank you. 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