Mitt Romney, who a year ago was heralding Massachusetts' health insurance law, sometimes fails to mention the far-reaching program when addressing conservative audiences today.
The reason may be twofold: During the past 12 months, Romney has moved from governor to Republican presidential contender, and some conservatives have criticized the plan as fostering big government.
The program, which Romney signed into law a year ago Thursday, includes a requirement that everyone in Massachusetts get some form of health insurance by July 1. If they don't, they face a series of increasing tax penalties.
That mandate amounts to an "unprecedented expansion of government power," says Michael Tanner, a health policy expert at the Cato Institute, a libertarian Washington think-tank.
The law also created the "Connector," a program for providing low-cost policies aimed at attracting younger and healthier residents who currently do not have insurance. Critics have questioned demands by the Connector's overseers for prescription drug coverage, as well as policies with premiums capped at $200 per month.
"There is a likening of this central concept of his - the Connector - to managed competition, which was at the heart of the 1993 Clinton health care proposal," Tanner said. "In essence, you have Romney embracing `Hillarycare,' and that doesn't play well on the right."
Sen. Hillary Rodham Clinton of New York, now a candidate for the Democratic presidential nomination, led a failed effort to create a national health insurance program during the first year her husband, former President Bill Clinton, was in office.
Romney dismisses such comparisons, saying specifically at campaign stops that the Massachusetts program is not "Hillarycare." Instead, he casts it as a compromise in which the government has created the environment for individuals to obtain private health insurance rather than relying on government-funded coverage at hospital emergency rooms.
The state's 550,000 previously uninsured will either get free insurance through Medicaid, state-subsidized policies or affordable private policies they can buy on their own. Even coverage for those already with insurance must meet state-prescribed minimums.
The insurance mandate, the former governor says, is a means of ensuring "personal responsibility," such as a state requirement for drivers to carry auto insurance.
"His view is that people who can afford to buy health insurance should do so or demonstrate they have the resources to pay their own way," said Eric Fehrnstrom, who served as gubernatorial communications director last year and now serves as a campaign spokesman. "They should not get government or other people to pay for them. His plan brought personal responsibility to health care just like work was brought to welfare."
A health insurance exchange
Nonetheless, Romney did not mention what Fehrnstrom described as "one of his biggest accomplishments" during a wide-ranging February speech to the Conservative Political Action Conference in Washington.
The absence was noted at the time, even though other conservative groups such as the Heritage Foundation have embraced his plan.
"The Connecter is a new market arrangement- a health insurance exchange - in which individuals and families can choose and own portable health insurance without the loss of the current generous federal tax benefits," Robert E. Moffit, the director of the Heritage Foundation's Center for Health Policy Studies, wrote in a recent policy memo.
Romney made a personal contribution of $25,000 to the think-tank in December 2005, although a Heritage spokesman said it had no influence over the group's opinions.
Romney invited Moffit to be the final speaker at last year's signing ceremony. Also attending the ceremony were a host of Democratic legislators, who overwhelmingly passed the bill, and Sen. Edward M. Kennedy, D-Mass., a frequent target of conservatives but a collaborator with Romney on the measure.