Health care issue like a persistent cough for Romney

So much for Mitt Romney escaping health care.

Reminders of the Republican presidential candidate’s signature achievement as Massachusetts governor — a sweeping state health care overhaul — are everywhere. And Democrats and liberals — from Supreme Court Justice Ruth Bader Ginsburg to President Obama to party faithful in Congress — are making sure everyone knows that Mr. Romney’s requirement that all people have health insurance was the basis of the federal mandate the Supreme Court just upheld as a tax.

“Congress followed Massachusetts’ lead,” Justice Ginsburg wrote in the landmark decision. By design or not, she ended up giving Democrats ammunition against Mr. Romney.

Mr. Romney has spent much of the presidential campaign shying away from talking about the law he signed as governor and Mr. Obama used as a blueprint for his national health care plan. Both measures require individuals to have health insurance, mandate that businesses offer health care to their employees and provide subsidies or exemptions for people who can’t afford it. Both laws also impose penalties on people who can afford health insurance but decide not to buy coverage.

The Supreme Court’s ruling Thursday highlighted those similarities.

Mindful of them, Mr. Romney long has sought to justify his position: He defends the Massachusetts law but says he would repeal Mr. Obama’s national version. The Republican also has tried to explain away comparisons between the two measures by telling audiences he would have been happy to help the president write a better law.

Mr. Obama “does me [a] great favor by saying I was the inspiration,” Mr. Romney has said. “If that was the case, why didn’t you call me? Why didn’t you ask me what was wrong?”

Since the court’s ruling, the Republican has taken care not to mention his state law. He left it out of his statement Thursday in response to the Supreme Court ruling and didn’t bring it up when he talked about health care at a private fundraiser Friday in New York.

“What happened yesterday calls for greater urgency, I believe, in the election,” Mr. Romney told donors. “I think people recognize that if you want to replace Obamacare you’ve got to replace President Obama.”

Since the ruling, GOP officials have criticized Mr. Obama by pointing out the Supreme Court’s determination that the requirement that all individuals carry health insurance is a tax. But in using that to cast Mr. Obama as a tax-raiser, Republicans risk turning the focus on their candidate. The state law Mr. Romney signed includes a similar penalty for people who don’t buy insurance.

Democrats have been hammering him on this point, citing a 2009 opinion column in which Mr. Romney wrote that Massachusetts “established incentives for those who were uninsured to buy insurance.” In the piece, he acknowledged that the requirement amounted to a tax: “Using tax penalties, as we did, encourages ’free riders’ to take responsibility for themselves.”