Editor's note: On April 12, the landmark Massachusetts health care law marks its 10th anniversary. Better known as Romneycare, it went on to become a model for federal reform. Our sister blog CommonHealth has been tracking the law since its inception, and today has a series of analyses. Links to the commentaries are gathered here and at the bottom of this post.
Ten years ago Tuesday, Mitt Romney made history, while making himself radioactive to certain corners of the Republican Party. On April 12, 2006, then-Gov. Romney signed the Massachusetts health reform to which his name would be epoxied informally.
Romneycare was historic because it became the model for Obamacare, the beginnings of a national health plan that had eluded presidents since FDR. Yet the Massachusetts law proved a Frankenstein monster for its creator when he tried to unseat President Obama in 2012. Romney labored futilely to convince Obamacare haters that his plan didn’t share DNA with the Affordable Care Act, only to belatedly acknowledge that he had indeed greased the skids for national reform.
Ten years ago Tuesday, Mitt Romney made history, while making himself radioactive to certain corners of the Republican Party.
So I don’t know if our former governor will mark Tuesday with a cake and a round of “Happy Birthday.” He should. His law not only did great good, it never became the political football that he and Republicans made of Obama’s. (Romney still favors replacing the national law with “state-crafted plans.”) And playing football with Obamcare is almost surely a losing game for the GOP.
Notwithstanding website failures and still-pricey out-of-pocket medical expenses, Massachusetts has gotten on with life under health reform. The law brought us to near-universal coverage, while medical costs rose at roughly the national pace. With health care a Democratic priority, leaders in this Democratic state resolved to support and tweak Romneycare (admittedly in ways Romney didn’t necessarily support).
Meanwhile, critics of the Affordable Care Act (ACA) still obsess over this alleged jobs killer. When the GOP Congress recently staged its 63rd impotent repeal vote, commentators couldn’t resist pointing out that it came on Groundhog Day, a meme for being trapped in time.
Here’s reality: Obamacare has coincided with, not killed, the jobs recovery from the Great Recession. Insurance premiums have risen more slowly since the act than before it. Even critics credit it with covering 17 million people, driving the uninsured populace down to a record-low 9 percent. That’s an indisputable achievement when you consider that un-insurance leads to thousands of avoidable deaths.
On the other end of the spectrum, progressive advocates of single-payer (government-funded) health insurance carp that the ACA failed to deliver us unto the Promised Land of Universal Coverage. But that’s not an inherent defect of partially privatized insurance, which achieves affordable, near-universal coverage in several nations.
Rather, the reasons for the persistence of uninsured Americans start with one that isn’t Obamacare’s fault: the ideological pigheadedness of Republican governors and legislatures in the 19 states that refuse to expand Medicaid to cover more poor people, despite Obamacare’s offer to foot 90 percent of the tab. “Medicaid expansion continues to be a huge predictor of how many people remain uninsured in a given state,” The New York Times reported.
Other factors crimping Obamacare’s reach are the off-putting complexity of many exchanges (online marketplaces where consumers buy insurance); inadequate federal subsidies (cheap plans on the exchanges can carry prohibitive deductibles), and rules disqualifying undocumented immigrants. Yet we are awash in ideas for fixing these problems.
Red-state voters should wake up and lean on leaders to expand Medicaid. The feds should spend more on simplifying exchanges and on subsidies to make plans more affordable. And for all his single-payer advocacy, Bernie Sanders improved Obamacare’s effectiveness by ensuring it included money for community health clinics, which are expected to serve 28 million this year, up from 18 million before the ACA. In a kumbaya moment, he had strong, if two-faced, Republican support. (Clinics are popular in GOP states, too.)
Romney's law not only did great good, it never became the political football that he and Republicans made of Obama’s.
We can also do more to control medical costs, beginning by allowing Medicare to use its market clout to negotiate cheaper drug costs. Importing cheaper drugs from Canada is another good idea. Anti-trust enforcement and, in certain cases, price regulation, have been suggested for reining in price gouging by hospitals.
Obviously, Republican leaders think they have a winning hand by continuing to rant against Obamacare instead of considering these fixes. Hillary Clinton thinks otherwise, telling audiences that the law’s benefits — millions insured, the popular requirement that insurers cover preexisting conditions — would be lost if Republicans get their way. The party’s leading presidential candidates either duck the question of how they’d replace Obamacare (Ted Cruz) or offer alternatives that would cover fewer people (Donald Trump).
In so doing, they’re even more AWOL in this debate than the conservative American Enterprise Institute, which once issued a paper advocating the ACA’s repeal while warning that a plausible replacement was essential. The paper offered such a plan, seven months before the 2012 presidential election. You know who won that one.
The Massachusetts Health Care Law Turns 10: What Analysts Say:
- Dr. JudyAnn Bigby, former state health and human services secretary
- Elizabeth Browne, director, Charles River Community Health
- Dr. Alice Coombs, former president, Massachusetts Medical Society
- Andrew Dreyfus, CEO, Blue Cross Blue Shield of Massachusetts
- Jon Gruber, economist, Massachusetts Institute of Technology
- Jon Hurst, president, Retailers Association of Massachusetts
- Amy Lischko, former Romney administration director of health care policy
- Rick Lord, president/CEO, Associated Industries of Massachusetts
- Lynn Nicholas, president/CEO, Massachusetts Hospital Association
- John McDonough, former director, Health Care for All
- Rep. Jeff Sanchez, House chair of the Joint Committee On Health Care Financing
- Nancy Turnbull, associate dean, Harvard T.H. Chan School of Public Health
- Josh Archambault, senior fellow, Pioneer Institute