During the Republican debate last Thursday, Mitt Romney defended the individual mandate in Massachusetts, which he signed into law as governor in 2006, while arguing against a similar mandate at the national level.

Romney’s argument centers on his claim that the decision to require people to buy health insurance coverage should be made by individual states.

“Under the tenth amendment, states have the right to do things that they think are in their best interest,” he said.

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During the debate, Romney also distanced himself from the Obama Administration’s health reform by saying, “But let’s - let’s point this out, our bill was 70 pages. His bill is 2,700 pages. There’s a lot in that 2,700 pages I don’t agree with and let me tell you, if I’m president of the United States, I will repeal Obama Care for a lot of reasons. One, I don’t want to spend another trillion dollars. We don’t have that kind of money, it’s the wrong way to go. Number two, I don’t believe the federal government should cut Medicare by some $500 billion. Number three, I don’t think the federal government should raise taxes by $500 billion and, therefore, I will repeal Obama Care.”

In a previous debate, Sen. Rick Santorum argued against Romney’s attempts to differentiate between ObamaCare and RomneyCare, saying, “Your mandate is no different than Barack Obama’s mandate. It is the same mandate.”

Santorum’s argument that a mandate would not work because people would choose to pay the fine rather than buy insurance, however, has not proven to be the case in Massachusetts, where 1.9 percent of the state’s residents were uninsured in 2010, compared with 16.3 percent nationally.

Despite the rancor shown over the issue during the debates, not everyone believes this is a political hot potato in Massachusetts.

“The individual mandate is not a real political issue in the state,” said Lynda Young, MD, president of the Massachusetts Medical Society (MMS). “There was a little bit of noise about a referendum to put it on the ballot to vote it out, but I haven’t heard anything more about it.”

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MMS supports the state’s individual mandate, Young added.

“Only 2 percent of the state is not covered,” she said. “It’s a major reason access to healthcare has been so successful for so many citizens.”

Instead, MMS and Young see reimbursement as a more dire issue for the state – and the nation. Indeed, many states have Medicaid troubles, including Arizona and Michigan, each of which held its primary on Tuesday.

In Arizona, despite disdain for the Patient Protection and Affordable Care Act, the state is moving forward on key health reform measures, including standing up a health insurance exchange (HIX). Michigan GOP Governor Rick Snyder, meanwhile, supported establishing an HIX, but Michigan's Republicans stalled the legislation when it reached the House.

“The biggest issue is payment reform,” MMS' Young said. “There are a waterfall of issues like how to cut costs, how to restructure payments to providers.”

For more of our primaries coverage, visit Political Malpractice: Healthcare in the 2012 Election.