A Healthy Blog

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

Ten Years of Making History in Health Care

Ten Years of Making History in Health Care

April 11, 2016

Ten years ago today, April 12, 2006, we all made history in health care. Just look (and you can click on the picture for the video):

Romney signing the health care law - Click to see the signing ceremony video

Since 2003. HCFA had been working on assembling a broad coalition in support of what was originally known as just Chapter 58, and later “RomneyCare.” Looking ahead then, we figured that 2006 was going to be the year of opportunity. We built the ACT! (Affordable Care Today) coalition of religious activists, the health care industry (hospitals, doctors, community health centers, insurers, nurses and more), labor unions, citizen activists and political leaders that really did make history. What’s more, the coalition stayed together after the reform law passed (becoming ACT!! – or, Act 2), and continues to be a force for effective implementation of access programs.

RomneyCare and Obamacare as identical twins?This cartoon overstates it – RomneyCare and ObamaCare are not identical twins (contra an exuberant Jon Gruber, and more on this below). But there’s no question that our achievement became the template for the ACA, and we would not have over 20 million more people nationally with insurance, and additional millions with more affordable coverage, without our law's success.

Another Anniversary

Today also marks another important anniversary. Exactly nine years ago, on April 12, 2007, the Connector Board approved its premium schedule for subsidized people in Commonwealth Care (now called ConnectorCare). The fight over the level of premiums was the first major implementation battle. We worked closely with the Greater Boston Interfaith Organization to bring real family budgets to the discussion, demonstrating the tight finances of low-income people struggling with the high cost of living in Massachusetts. We were pleased that, in the end, on 4/12/2007, the Connector board ended up agreeing with us. As we said then, “We have achieved affordiosity.” These affordable premiums, along with no deductibles and modest copays in the subsidized plans, led to a surge of enrollment, bringing the coverage rate here up to around 97%.

But when the ACA was being designed, they deviated from the Massachusetts experience. Subsidized Obamacare plans have much higher premiums, and included deductibles and larger copays. In large part, this was due to the need for Congress to meet overall federal spending targets. The result is a stark difference in affordability:

Higher premiums under the ACA

We think this explains in part why Massachusetts enrollment has been better than the rest of the country - even states that have expanded Medicaid. The next frontier for Obamacare after Obama is more affordable coverage for low income people.

Still More To Do

We’re not done, though. This call from the Blue Cross Foundation points to continued challenges for all of us:

Health Reform at 10: Still must address access and affordability gaps

There are still significant gaps in coverage, affordability is a major issue for many, we are far from parity for behavioral health care, and dental coverage continues to lag way behind medical coverage (we, of course, think both should be closely integrated). The administration is proposing eligibility cuts to the Health Safety Net program, and benefit cuts for some in MassHealth. Racial and ethnic disparities persist, and public health continues to be left behind.

So, congratulations to us all, for 10 years of progress. And, we're not done yet.

                    -- Brian Rosman