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The Challenges of Taking the Massachusetts Health Coverage Law National

One by one, health care leaders on Capital Hill are filing plans to cover the uninsured modeled on what is happening in Massachusetts. Last week it was Senator Max Baucus; President-elect Barack Obama campaigned on a Massachusetts styled proposal and Senator Ted Kennedy is expected to throw his power behind something similar. But would the state's health coverage law work on a national scale? We pose that question to people who helped write and others who are implementing the law.

MARTHA BEBINGER: The architects of the Massachusetts health coverage law are proud of what it has accomplished. 440-thousand residents have signed up for insurance since the law was passed two and a half years ago. The state’s uninsured rate has dropped to about 3%...well below any other state in the country.

RICK LORD: But Massachusetts started off in a different place than the rest of the country.

BEBINGER: Associated Industries of Massachusetts president Rick Lord.

LORD: We had a relatively small number and finally we were spending a lot on the uninsured to start with, so we had a lot on the uninsured to start with so we had a lot of money in the system that could be redirected to providing premiums for the uninsured.

BEBINGER: Massachusetts also had overwhelming political support in attempting to be the first state to cover the uninsured.

The Governor, the Senate President and the House Speaker all made passing the law a top priority. The bill that cleared the Senate unanimously and the House with only 2 dissenting votes did not require new taxes, as a federal bill would likely need to do. Jon Kingsdale runs the Connector, the agency charged with implementing the state’s coverage plan. Kingsdale says he would not try a major health coverage effort on a nation scale without knowing he had broad support.

JON KINGSDALE: Implementing that is just as challenging as getting it enacted, you want something more than a 51/49% margin to make this kind of fundamental change and have it continue to be supported as it is implemented by the American people.

BEBINGER: Strong support has been critical, for example, as costs exploded. Enrollment in the state’s free and subsidized health insurance programs jumped past expectations and the state was forced to roughly double funding last year. The national experience might be different because covering the uninsured is more expensive in Massachusetts than in most other states. Nancy Turnbull is an adviser to lawmakers who wrote the bill and is now a member of the board charged with making it work.

NANCY TURNBULL: We are in Massachusetts the most expensive place on the face of the globe to get care. That suggests that the cost of expanding coverage many other places, while it would be greater because there are more uninsured people, the cots of providing care is lower and that will redound to the benefit of other states.

BEBINGER: While many who helped craft the law celebrate expanded coverage…and the fact that public and political support remains strong…they warn that it is still a work in progress. Michael Widmer, president of the Massachusetts Taxpayers Foundation is nervous about health care costs.

WIDMER: We can’t pay for health care indefinitely when we’re seeing 10% growth each year. That’s simply not sustainable. So as successful as we’ve been here in Massachusetts, on the long term success, the jury is still out.

BEBINGER: A key piece of the success, so far, is cooperation among the board created to implement the law. In Massachusetts, the legislature did not define key elements…such as what is affordable coverage or what is adequate health insurance. Those decisions have been left to the Connector board where there have been many heated discussions…but only vote that was not unanimous. Connector board member Celia Wcislo, with the Service Employees International Union, hugs the head of the state’s largest employer group, Rick Lord, before stopping to talk about how this diverse board gets to consensus.

CELIA WCISLO: From the beginning we had our yelling and hissy fits about different things. I think in the end of day, we all started listening to each other too and not just holding on to our needs and perspectives, but recognized, if us 10 can’t figure out how to do this, how do we expect the outside community to think there’s something that can get done.

BEBINGER: Lord is not optimistic that the Connector board’s unified commitment could be recreated in Washington D.C.

LORD: Hard to picture this occurring at a national level, just because the discourse nationally always seem to be much more difficult than it is here in Massachusetts. I think it will take great leadership to make this happen nationally.

BEBINGER: Elected leaders nationally are meeting with employer groups, unions and health policy experts about whether they’ll be able to put aside differences in favor of getting a bill passed that will start to control health care spending and cover the uninsured. And why are they using Massachusetts as a model…given all the ways this state is unusual? Rick Lord says there’s it much choice.

LORD: There’s no other model in place in the US right now that is working like Massachusetts, where we have almost achieved universal health care, so we’re the model that exists and I think a lot of people hope the country can adopt it or something close.

BEBINGER: One more difference to mention…Massachusetts launched programs to cover the uninsured while the economy was still relatively healthy. Now, there’s debate about whether the nation’s economic downturn will undermine health reform efforts or whether desperation about fixing health care will forge a winning compromise.

This program aired on November 18, 2008. The audio for this program is not available.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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