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Republican presidential candidate Mitt Romney made some health news in his interview on the CBS program "60 Minutes" the other night. At issue here is the candidate's plan for the Medicaid health program for the poor. NPR's Julie Rovner reports Romney's position, now, is different than it was a year or two ago.
JULIE ROVNER, BYLINE: When CBS's Scott Pelley asked Romney for an example of a federal program he'd turn back to the states, Medicaid was among those he volunteered. And how would that save money for federal taxpayers, Romney was asked.
(SOUNDBITE OF TV SHOW, "60 MINUTES")
MITT ROMNEY: Because I'd grow them only at the rate of inflation, or in the case of Medicaid, at inflation plus one percent. That's a lower rate of growth than we've seen over the past several years, a lower rate of growth than has been forecast under federal management. And I believe on that basis you're going to see us save about $100 billion a year.
ROVNER: Now, Romney, his running mate, Wisconsin Congressman Paul Ryan, and other conservative Republicans have said they think states can do a more cost-efficient job running Medicaid without interference from the federal government. But most Democrats think that cutting that much out of Medicaid would do serious harm to the program and the nearly 60 million people it currently serves.
HAROLD POLLACK: When you have that level of deep cuts to Medicaid, there are only so many ways that it can play out.
ROVNER: Harold Pollack is a liberal health policy expert and a professor of public health and social science at the University of Chicago.
POLLACK: Fewer people will be eligible for services. Fewer services will be covered. Providers will be paid less or state governments will be faced with some very difficult challenges to make up the money with their own budgets. And they're not really in a position to do that.
ROVNER: But it was something else that Romney says in the "60 Minutes" interview that really got the health care chattering class abuzz. That came when Pelley asked the candidate if he thought the government has a responsibility to provide health care to the 50 million Americans who don't have it today. Here's how Romney responded.
(SOUNDBITE OF TV SHOW, "60 MINUTES")
ROMNEY: Well, we do provide care for people who don't have insurance. People - if someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital and give them care. And different states have different ways of providing for that care.
ROVNER: That was basically Romney's way of saying that people who don't have insurance can always go to the hospital emergency room. Yet, here's how he commented on that exact same subject in an appearance on MSNBC in 2010.
(SOUNDBITE OF MSNBC BROADCAST)
ROMNEY: It doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility.
ROVNER: Back then, Romney was defending the Massachusetts plan he signed as governor. The one that requires most people to either have health insurance or pay a fine - just like the federal law he now vows to repeal. He used even more colorful language back in 2007, talking to Fox News host Glenn Beck.
(SOUNDBITE OF FOX NEWS BROADCAST)
ROMNEY: When they show up at the hospital, they get care. They get free care paid for by you and me. If that's not a form of socialism, I don't know what is.
ROVNER: Of course, in addition to flip-flopping, Romney is missing a critical fact about the uninsured and emergency room care, says health policy professor Harold Pollack. Just because hospitals are required to see patients in the emergency room doesn't mean that care is required to be free.
POLLACK: The emergency room is perfectly entitled to send you a whopping bill. And there are many people across America who are facing significant financial problems from serious bills that they've received for emergency care.
ROVNER: It's only when the uninsured don't, or can't, pay those bills that the costs come back to the taxpayers. Pollack also says that Democrats and Republicans largely agree that emergency rooms are wholly inappropriate places for most people to get health care.
POLLACK: It's just about the least cost-effective way you can get your medical care. And we also have really damaged the institution of emergency department care by expecting it to take on these burdens that it's not really designed to assume - to provide primary care to low-income people.
ROVNER: Romney is always quick to say he still supports the law he signed in Massachusetts. He simply doesn't want to require other states to do the same thing. But one of the continuing ironies of his health care position is that it was hundreds of millions of federal dollars that made the Massachusetts health law feasible. Under a Romney administration, other states likely wouldn't get a similar chance.
Julie Rovner, NPR News, Washington.