But Timothy R. Murphy, Romney's human services secretary, said of the fee: "We didn't believe it was the linchpin. When you're talking about billions of dollars, it was pretty inconsequential."

Kennedy had a prominent place at the signing ceremony. But today, stumping before conservative audiences, Romney uses his sometime ally as a laugh line. At a National Review forum in January, Romney said: "I was a little concerned at the signing ceremony when Ted Kennedy showed up."

In fact, Romney invited the senator. "It was a joke, obviously," Romney said of his National Review comment.

It remains uncertain whether the law will succeed, but it has already shaped the national debate around health care, according to U.S. Health and Human Services Secretary Michael Leavitt.

"I'm now working with 25 states to develop some version or all of the things Massachusetts has done," said Leavitt, who, as governor of Utah, recruited Romney to take over the 2002 Olympics. "I don't know if what Mitt Romney did is a conservative idea or a liberal idea, but it is clearly an innovative idea."

Trending right

If the politics of Romney's health-care plan were difficult to categorize, his overall political direction was not: He was moving to the right, away from the state that elected him and toward a national audience of conservative Republican voters.

The Romney of 2002, so attractive to moderates and independents, became unabashedly conservative on hot-button social issues.

His shift is traceable in part to what he describes as an awakening on an entirely new issue — stem cell research.

In February 2005, Romney stunned and upstaged Travaglini, who had introduced legislation to advance embryonic stem cell research, by announcing in a New York Times interview that the bill's provision for a technique known as therapeutic cloning would "cross the line of ethical conduct."

As a candidate for governor, Romney supported stem cell research but refused to take a stand on the cloning procedure, which is one way to create embryonic stem cells. In the course of the process, which many scientists believe holds promise for developing treatments of major diseases, the embryos are destroyed.

Romney aides say he arrived at his position after heartfelt reflection. But after he announced he would veto the bill, others saw a governor preparing for a presidential race.

"There's evidence that he is clearly concerned with the national agenda," Travaglini said at the time. (On the campaign trail, Romney, unlike many conservatives, endorses using leftover embryos from fertility treatments for medical research.)