A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Brown / Coakley and Massachusetts Health Reform

Brown / Coakley and Massachusetts Health Reform

January 19, 2010

We always knew that national health reform policy was going to be very dependent on Massachusetts. From the very beginning, we heard that Washington policy path was following "Massachusetts Avenue." One Washington staffer said the goal was to do "Massachusetts, but better." And so the bills passed by both the House and Senate owe their policy basics to chapter 58. People with experience here - John McDonough, Jon Gruber, and even us, to some extent, played an important role and passed on our knowledge.

Implementation, too, was always assumed to learn from our model. This Thursday and Friday, the Connector along with national partners are hosting officials from 42 states to talk about building exchanges. Next week HCFA's Helpline Director is speaking at a national conference for consumer advocates.

But we didn't expect that the politics of health reform would depend on Massachusetts as well. Isn't that too much to put on one state? Why us?

Anyway - the intersection of the national media, repeating cliche (and often wrong) common wisdom about Massachusetts health reform, and the Senate race is getting harder to bear. One thing stuck out today.

Scott Brown repeated again today his "reason" for opposing national health reform, in a statement from his spokesman (and Romney spokesman during 2006 and today), Eric Fehrnstrom:

"In Massachusetts, 98 percent of residents are covered by insurance through our own state reforms. The plan is not perfect, and we need to get costs down, but we have already achieved near-universal coverage. There is nothing for us in a national plan except higher taxes and more spending to finance coverage expansions in other states. It's a raw deal for Massachusetts," he said.

On both policy and politics, this makes no sense.

Last week, Jack Sullivan at CommonWealth Magazine's CW Unbound blog did a smart job responding on the substance. On a pure financial basis, the national bills would be a huge boost for Massachusetts. Federal tax credits could replace much state spending for Commonwealth Care, enhanced Medicaid reimbursements would relieve pressure on the MassHealth budget, and new Medicare drug assistance would allow us to save much of our Prescription Advantage budget. For the overall state economy, the effect is even more positive. The federal bills include new tax credits for small businesses, a large ramp-up in health research, and strengthened federal support for Community Health Centers, medical education, and other areas that play to Massachusetts' strength.

While there is some uncertainty (we don't have a final bill yet), we think Jon Kingsdale's observation is on the mark: "I can say unequivocally, the long-term risk to Massachusetts would be immense should this go down to defeat. We’d be stuck with footing the entire bill.” Scott Brown's claim is just wrong.

The New Republic's Jon Cohn deals with the political angle. It's the popularity of Massachusetts health reform that leads Brown to not call for its repeal, even as he opposes national reform that is in many ways more conservative than chapter 58. This validates the general understanding that once health reform is passed, and it starts providing real benefits to the population, support will rise.

While some national pundit bigfoots (we're talking about you, Howard Fineman and Chuck Todd, for example) see tomorrow's election as some kind of referendum on health reform, we think they have missed the point. Hardly any of the ads focus on health reform, and there's way too much other stuff going on here.

What do you think?
-Brian Rosman