"National Health Care Reform – What’s In It for Massachusetts?" by Anya Rader Wallack

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Now that the dust has settled on the Democratic Presidential primary, those of us who are fixated on politics and health policy have begun to focus on the next major frontier — the potential for some sort of significant health care reform at the national level following the November election. There’s no question that the country is poised to make history on health reform. The public is clamoring for change and the candidates are listening.

Both of the presumptive presidential nominees, Barack Obama and John McCain, have articulated proposals for major changes in the health care system if they are elected. While their plans differ in significant ways, they each have the one thing in common that we must carefully monitor: the potential for a major impact on the success of the Massachusetts health reform plan.

Obama proposes an expansion of Medicaid and SCHIP, and a system of income-based subsidies for those who do not qualify for public coverage.

He supports a requirement that all children have insurance, and an employer mandate, but does not support a mandate for adults. McCain proposes tax credits for individuals and families to purchase private coverage, plus a subsidized high-risk pool for people who have been denied insurance coverage due to their health status. He also supports changes in the tax laws that currently make it much less expensive to purchase coverage through an employer. Both candidates propose some flexibility for state-based health reforms, a key concern for Massachusetts.

A framework of comprehensive national health reform offers tremendous potential benefits for Massachusetts, particularly in terms of solidifying the legal and financial underpinnings of Chapter 58. But we must not forget that the continued success of Chapter 58 rests upon strong and consistent financial support from the federal government. And that’s where the Massachusetts plan, a national model that has given policymakers the only real-life example of the costs, benefits, and mechanics of universal coverage, may face its biggest threat. In the context of a national debate about the distribution of new federal resources to cover the uninsured, Massachusetts might experience a profound lack of empathy from other states. Why? Several reasons:

- Massachusetts has relatively low rates of poverty and uninsurance. With 15 percent of our population below the poverty line and less than 10 percent uninsured, we may be viewed as less needy than states like California, New Mexico and Texas, which are at or above 20 percent on both measures.
- Massachusetts already receives more federal funding for Medicaid, on a per capita basis, than many states. The federal government spent about $766 per capita on Medicaid in Massachusetts in 2006, compared with a national average of $595.
- Massachusetts has relatively high health care costs. Our per capita health care expenditures, at $6683, are well above the national average of $5283, and our health insurance premiums exceed national averages ($12960 for a family premium in Massachusetts versus $12108 nationally).

We can take comfort in the fact that Senator Kennedy is already taking the lead on crafting consensus national health care reform legislation, and the Senator and his staff obviously have the state’s interests at heart. But we should not take for granted that a national plan will serve our needs, and we should continue to make a strong case that Massachusetts is a model for reform, and success in Massachusetts serves the entire nation.

Anya Rader Wallack is the executive director of the Massachusetts Medicaid Policy Institute. She is also a member of Barack Obama’s National Health Policy Advisory Committee and his New England Finance Committee.

This program aired on July 11, 2008. The audio for this program is not available.