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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.


And I'm Robert Siegel.

Most of the coverage of last night's Republican debate has focused on the clashes between Newt Gingrich and Mitt Romney over relatively personal issues. Those include Romney's wealth and whether or not Gingrich ever lobbied.

As NPR's Julie Rovner reports, this 19th debate also featured one of the liveliest exchanges yet over the very public issue of health care.

JULIE ROVNER, BYLINE: The health issue was raised, not by a member of the media, but by a voter, Jacksonville resident Lynn Frazier. She described herself as unemployed for the first time in 10 years.

LYNN FRASIER: And unable to afford health care benefits. What type of hope can you promise me and others in my position?

ROVNER: None of the candidates pointed out that Ms. Frazier would likely get help under the Affordable Care Act, the federal law that passed in 2010. Depending on her income, she'll either be eligible for Medicaid or a subsidy to help her buy insurance starting in two years.

One thing all the candidates agree on is they want to see that law repealed. But Frazier's question sparked quite a debate between former Senator Rick Santorum and former Massachusetts Governor Mitt Romney.

Santorum said the Massachusetts law passed under Romney's stewardship in 2006 is too close to the federal law for Republicans to make health care an issue this fall.

RICK SANTORUM: And it does not provide the contrast we need with Barack Obama if we're going to take on that most important issue. We cannot give the issue of health care away in this election.

ROVNER: Romney insisted that's not the case, that the Massachusetts law and the federal law differ in significant ways. But then he launched into an eloquent justification for the requirement at the heart of both measures, the so-called individual insurance mandate.

MITT ROMNEY: 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. We're insisting on personal responsibility.

ROVNER: In fact, says John McDonough, a professor at the Harvard School of Public Health, Romney did something President Obama himself failed to do in his State of the Union earlier this week.

JOHN MCDONOUGH: Romney has given, in this entire presidential campaign, last evening, what I believe is the most effective and persuasive rationale and defense of the individual mandate.

ROVNER: The bad news for Romney, however, at least in a GOP primary, is that it's not just the individual insurance requirement that the Massachusetts and federal health laws have in common, says McDonough, who was intimately involved in the drafting of both measures.

MCDONOUGH: And the similarities go far, far beyond the mandate. The essential architecture of the insurance reforms in the Affordable Care Act are taken wholly from the Massachusetts health reform laws.

ROVNER: On the other hand, Santorum may have over-spoken when he claimed that the Massachusetts law isn't working very well. Sharon Long is a professor at the University of Minnesota. Just this week, the policy journal Health Affairs published her study looking at the Massachusetts program's first five years in operation. She says, overall, the state's doing very well in terms of getting nearly all of its citizens insured.

SHARON LONG: Including this year - for the first time, we're seeing reductions in emergency department use and also some improvements in health status. So, really, some very positive changes that came with health reform.

ROVNER: Positive for Massachusetts' residents, perhaps. Positive for Mitt Romney's chances to win the Republican nomination? That still remains to be seen.

Julie Rovner, NPR News.

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