"We're troubled by it," Dean Clancy, who runs health care advocacy for the Dick Armey-led conservative group FreedomWorks, told TPM Monday via email. "We're very concerned. The tea party grassroots have always feared that Gov. Romney would be a weak standard bearer because of RomneyCare. This choice only reinforces those doubts. Tapping a high-profile ObamaCare profiteer is disturbing, there's no way around it. ... The tea party has been fighting exchanges in state after state."
Michael Cannon, who directs health policy for the libertarian Cato Institute, reacted to the Leavitt choice in a blog post he penned: "Romney's appointment of Leavitt is a first step toward flip-flopping -- or Etch-a-Sketching, or Romneying(TM), or whatever -- on ObamaCare repeal."
The Romney campaign didn't comment for this article but has been attentive to the right's concerns. Spokeswoman Andrea Saul assured National Review and the Daily Caller that the buck stops with Romney and said he remains as committed as ever to repealing "Obamacare."
There's a deeper irony to the conservative gripes with Leavitt. The idea of insurance market exchanges is rooted in conservative thinking and continues to be embraced by the right in different contexts. Under Republican leadership, Utah enacted state exchanges in 2005. Today, the Paul Ryan budget that congressional Republicans -- and Romney -- strongly support would transform Medicare into an insurance exchange similar in structure to "Obamacare."
For Romney, the danger is that his enactment of a health care reform law in Massachusetts that's virtually identical to "Obamacare" has conservatives routinely questioning his commitment to repealing the law they detest. More broadly, his history as a moderate forces him to work doubly hard to close any potential rifts with the right, which he has shown an eagerness to do even after securing the Republican nomination.
[C]onservatives and libertarians are right to be concerned. Personnel is policy, after all," Domenech told TPM in an email. "What's more concerning is the role Leavitt may play in determining policy going forward. Perhaps the biggest policy question facing Mitt Romney should he become president will be the replacement of President Obama's health care law."