Governors Report Card: How Romney, Huntsman, Perry Changed Health Care

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"Our plan was a state solution to a state problem. [Obama's] is a power grab by the federal government to put in a place a one-size-fits-all plan," Romney said at a speech at the University of Michigan Cardiovascular Center in May. Whether or not Romney's plan is right for the country as a whole, it has achieved some of its goals within Massachusetts.

In the first three years after Romney signed the health care law, the percentage of people without health insurance dropped from 9 percent in 2001 through 2005 to 5 percent by 2009. Massachusetts now has the lowest percentage of the population without health insurance in the country.

Conversely, Texas has the highest percentage of uninsured people. In the Lone Star state, about one out of every four Texans does not have health insurance. During Perry's 10 years as governor, the uninsured rate has risen slightly from 22 percent in 2000 to 26 percent in 2009.

Levitt said Texas' high rate of uninsured people is in part because the state has a large number of retail and service jobs that typically do not provide insurance. Massachusetts, on the other hand, has a lot of high-tech employment and jobs that come with insurance packages.

"A lot of people in Texas are starting off behind the eight-ball because they aren't starting off with jobs that offer health insurance," Levitt said. "A lot of that is simply endemic to the structure of a state."

One thing governors can control is state spending on Medicaid, which affects how many people qualify for the low-income insurance program. Texas has "one of the stingier Medicaid programs" Levitt said, so fewer Texans can rely on public insurance.

Perry has attacked both Romney and Obama for what he called their "socialist proposals" of requiring everyone to have health insurance.

"Mandates are both painful to rank-and-file Texans and also extremely ineffective. Don't ask me, ask Massachusetts. In the Bay State, where a mandate is already a fact of life, premiums are 40 percent more expensive than elsewhere in the country, and it's becoming harder and harder to find a doctor to see even if you are covered," Perry wrote in an Austin-American Statesman op-ed shortly after President Obama signed the Affordable Care Act.

While Perry's claims may be slightly exaggerated, Massachusetts' insurance premiums have become more expensive since Romney signed his health care law.

Premium cost increases outpaced the national average in 2009, increasing by 10 percent for private insurance compared to a 4.6 percent increase nationally, according to the Massachusetts Division of Health Care Finance Policy. Health care changes in Texas have been primarily related to family planning funding and women's health. In the past legislative session, Perry fast-tracked a sonogram bill that requires women seeking an abortion to have a sonogram at least 24 hours before the procedure.

The sonogram bill also requires doctors to describe the size of the fetus' limbs and organs, even if the woman does not want to hear it and make the sonogram image of the fetus and its beating heart available to the woman.

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