MA Health Reform on the Presidential Campaign trail

Polls show that health care will be one of the top domestic issue for voters in the next presidential election. With many of the leading Democratic candidates drawing on the Masachusetts model to cover the uninsuredl...we ask...why... and would the plan work on a national scale? WBUR’s Martha Bebinger has some answers.

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When Hillary Clinton answered questions about her health plan during a campaign webcast last week…she could have been describing much of the Massachusetts health care law.

Individuals have to do their part just like employers just like the providers who take care of us. The drug and insurance companies have to change the way they do business and of course the gov’t has to participate. So its shared responsibility, but it really does rest on the individual.

Clinton and one primary opponent, Senator John Edwards, support mandatory health insurance. Barack Obama does not. All three would offer the uninsured subsidized coverage and more affordable insurance options, as does Massachusetts. And like the Commonwealth, these candidates would require that most employers insure workers or pay to help cover the uninsured. None of the candidates' plans mirror Massachusetts. But whether the leading Democrats adopt a little or a lot of what is being tested in the Bay State, MIT health economist Jon Gruber says the Massachusetts law, unlike more sweeping single payer options, is viable.

They realize that the kind of rip it up and start over again approach is not going to work with the American voter and that this approach we started here in Massachusetts, which I call universal incrementalism, which is get there in pieces, but get there, is doable.

More than 47 million Americans lack health insurance…but Massachusetts is stepping up to the plate

The state may be catching the candidates' attention in promotional videos.

With MA health care reform, more than 170-thousand people now have the health insurance they need.

But not everyone supports the law and how much backlash it will create is still an open question. There is little organized opposition, but there are many cynics. Nicholas Manousos, a 47-year old uninsured carpenter, stops work on a bar in Watertown to talk about his frustration with the requirement that all adults must have health insurance.

It’s basically a PR stunt from my view. They did it politically so they can claim we are going to cover everybody and we’ll just pass a law and make em pay for it.

The first penalties for failure to have health insurance kick in next year, at the same time that Clinton, Edwards or Obama may be going head to head with a Republican nominee, defending their health care plans. Connector director Jon Kingsdale, who runs the state effort to cover the uninsured, says adopting parts of the Massachusetts plan, while it is in the test phase, is a gamble.

There is no underestimating the risk of trying to deal with national health insurance. We got all too many lessons about how it looks like it is within reach and then turns around a bites somebody who is trying to lead the way.

Kingsdale says a health insurance requirement could work nationally as long as there are affordable options. But he offers some warnings.

I think it can translate, but not if it’s just rammed down the throat of the country with a slim majority. One of the things we were able to do here, was get this enacted with very, very broad support. I wouldn’t want to try to implement this on a 51 to 49 vote.

In addition to the politics there’s the question of funding. Kingsdale says Massachusetts was spending more on care for the uninsured than any other state before the universal coverage law passed. Clinton, Edwards and Obama would all reverse tax breaks approved during the Bush administration to help fund national coverage for the uninsured. Stuart Altman, who teaches national health policy at Brandeis University says these candidates understand that most states don’t have any extra money for universal coverage.

They recognize that at the national level, the federal government has to do more because poorer states just can’t do what Massachusetts did.

Even though the Massachusetts law is still a work in progress… author, surgeon and Harvard Medical School Professor Atul Gawande says it holds the most promise on what Democrats hope will be a defining domestic issue.

The chapter in Massachusetts has not already been written, but it has shown more hope for the possibility of change and that’s why people have gravitated towards the ideas.

Although not Republicans. None, including former Governor Mitt Romney, who proposed the requirement that everyone have health insurance in Massachusetts, support that idea or a major government investment in universal coverage.