WASHINGTON — 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 — now are everywhere. And Democrats and liberals — from Justice Ruth Bader Ginsburg to President Barack Obama to party faithful in Congress — are making sure everyone knows that Romney’s requirement that all people have health insurance was the basis of the federal mandate that the Supreme Court just upheld as a tax.

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

Romney has spent much of the presidential campaign shying away from talking about the law he signed as governor and that Obama used as a blueprint for his national health care plan. Both measures require individuals to have health insurance, mandate that businesses offer healthcare 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, Romney long has sought to justify his position: He defends the Massachusetts law but says he would repeal 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.

Obama “does me great favor by saying I was the inspiration,” 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,” Romney told donors. “I think people recognize that if you want to replace Obamacare you’ve got to replace President Obama.”

In the day since the ruling, GOP officials have criticized 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 Obama as a tax-raiser, Republicans risk turning the focus on their candidate. The state law 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 piece in which 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.”

Perhaps past statements like that are why Romney has been careful not to emphasize the court’s characterization of Obama’s mandate as a tax. Instead, Romney notes that the federal health law includes roughly $500 billion in new tax revenue — an argument he has been making for months.

That number, a campaign spokeswoman said, comes from Congressional Budget Office testimony from March 2011. It refers to a figure that doesn’t include the $54 billion that the government expects to collect from people who pay the penalty instead of complying with the requirement to purchase health insurance over the next 10 years.

While Romney pointedly has downplayed the connection between Massachusetts and the national law, some fellow Republicans haven’t been as careful.

“There’s only one candidate, Gov. Romney, who has committed that he will repeal the Obamney, uh, the Obamacare tax increase,” Republican Louisiana Gov. Bobby Jindal said Friday during a conference call organized by the Republican National Committee.

In the unforced error, Jindal inadvertently invoked a phrase coined during the primary by former Minnesota Gov. Tim Pawlenty, who dropped out of the presidential race shortly after trying to attack Romney by dubbing the health care law “ObamneyCare.”

Former Pennsylvania Sen. Rick Santorum was more direct in linking the state and federal laws. “I think what you’re seeing is it hasn’t worked in Massachusetts,” the former Pennsylvania senator told CNN Thursday night.

Santorum is backing Romney now, but during the primary, he cited health care as the reason why Romney is “the worst Republican in the country to put up against Barack Obama. Former House Speaker Newt Gingrich, another rival, called it “a forerunner of Obamacare.”

Back then, Texas Rep. Ron Paul, who largely steered clear of attacking Romney during the GOP debates, also wrote to Iowa supporters that Romney “fought for state-run health care while governor, but now laughingly wants you to believe he will fight to repeal Obamacare.”

During the primary, Romney struggled to distance himself from the law partly because he risked stoking longtime criticism that he is willing to change his core beliefs for political gain.

“I’m not going to change my positions by virtue of being in a presidential campaign,” Romney told Fox News in the days leading up to the Iowa caucuses. “What we did was right for the people of Massachusetts.”

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Peoples reported from New York. Associated Press writers Andrew Taylor in Washington and Steve LeBlanc in Boston contributed to this report.

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