Mass. health plan seems unlikely to be US model
Demographics in state's favor
Governor Mitt Romney is basking in the glow of a national spotlight. Lawmakers and advocates are buzzing in state capitals from New York to California about Massachusetts' new compulsory health insurance plan.
But even as the law to expand health insurance coverage to virtually every resident makes headlines nationwide, some executives and advocates say it is unlikely to serve as a national model.
James J. Mongan, chief executive of Partners HealthCare, the largest hospital and physician network in New England, said he told physicians and scientists at an Institute of Medicine conference in Washington, D.C., this week that the Massachusetts plan would be difficult to duplicate elsewhere.
Mongan, who has worked on healthcare expansion initiatives for 30 years -- including a stint in President Jimmy Carter's administration -- said the state's unique circumstances made it ripe for healthcare reforms.
Massachusetts has relatively few uninsured residents, about 10 percent compared to about 18 percent nationally. It already spends more than $500 million in federal and state money annually to compensate hospitals for treating the uninsured. As a result, Mongan said, Massachusetts faced the relatively simple task of redirecting that money to insurance coverage rather than the more politically challenging job of raising it.
''We started with half the problem solved," Mongan said.
The state also has a Republican governor who was willing to earmark an anticipated revenue surplus for expanded coverage, Mongan added, while most Republican governors would have used it for a tax cut.
''I think it's going to be difficult for other states" to implement similar reforms, he said.
Legislatures in at least seven states are considering various forms of expanded health insurance coverage this year, according to the National Conference of State Legislatures.
Other states have already taken a variety of steps in the direction of universal coverage. In 2003, Maine passed a law to make coverage available for all residents by 2009; Hawaii requires all employers to contribute to healthcare coverage for their workers; and Illinois has adopted a program to provide coverage for residents under 18 years of age.
Massachusetts has vaulted into the forefront, not just because it passed a law that promises near-universal coverage by 2009, but because the legislative compromise bridged longstanding differences between healthcare advocates and employers over the issue.
But nationally, Massachusetts' individual mandate -- which requires that all residents obtain health insurance as long as ''affordable" policies are available -- has been attacked from the right and left of the political spectrum, illustrating the problems other states would have passing similar legislation.
Some conservatives consider the mandate a government intrusion on individual rights. Liberals say it is unfair to force people to purchase insurance that they fear will be too expensive for many even if the state deems it affordable.
The state's $295-per-employee annual levy on businesses that do not offer health coverage also is being greeted with some skepticism in other parts of the country.
''Massachusetts is a very liberal state. The political culture in other states is so different. I don't think you can expect employer mandates to go anywhere in other states," said Robert E. Moffit, director of the health policy center at the Heritage Foundation, a conservative nonprofit organization in Washington.
Some less sweeping elements of the Massachusetts reform plan could gain traction elsewhere, said some observers. Moffit and Timothy Murphy, Romney's secretary of health and human services, cited the provision to combine individual and small-group insurance policies under a central agency, called a ''connector," to offer a range of lower-cost insurance options.
''This idea of creating a consumer-based insurance market is different," Moffit said. ''Nobody in America has ever done anything like this."
Murphy said another facet that could be attractive to other states is the reform plan's call for public disclosure of hospital costs and performance to help consumers and insurers choose lower-cost, high-quality medical care.
In the end, however, the biggest impact of the Massachusetts experience on the national level may be political.
Generally, politicians favor either an individual mandate or an employer contribution.
Health Care for All, the state's most influential healthcare advocacy group, was able to persuade legislators to include both in the reform plan.
''The default for politicians is to do neither," said John McDonough, the group's executive director. ''The striking and innovative thing here is that [House Speaker Salvatore DiMasi] said let's not do neither, let's do both."
That political breakthrough may encourage other states to tackle longstanding barriers to reform, said Ron Pollack, executive director of Families USA, a national healthcare advocacy group in Washington. D.C.
''There are significant elements of the Massachusetts proposal that are likely to get serious consideration in a number of states," Pollack said. ''We have got to find ways to cobble together different approaches. That is the only way I think you can make significant headway."
Brandeis University health policy professor Stuart Altman likened the national attention the Massachusetts law has received to the focus on universal healthcare that followed the candidacy of former Pennsylvania Senator Harris Wofford, who won a special election by focusing his campaign on expanding insurance coverage nationally.
His victory made healthcare a prominent topic during the 1992 Democratic presidential primary season and in Bill Clinton's subsequent campaign, even though Clinton's effort to create a national healthcare system eventually failed, Altman said.
''Every once in a while, a political person or event comes up and kicks this thing into the mainstream," said Altman. ''The Massachusetts plan could become a catalyst and a galvanizing event at the national level, and a catalyst for other states."
Christopher Rowland can be reached at crowland@globe.com. 