CVS hung signs in its storefronts promoting the law. Supermarket chains like Shaw’s and Star Market printed similar messages on store receipts. H&R Block provided its uninsured tax clients with information on how to sign up through the exchange.
The state also gave grants to community groups to help individuals fill out their enrollment forms. Health care providers, too, completed forms on behalf of patients. Radio ads in Portuguese and other languages targeted immigrant groups. Churches reached out pew by pew, scouring their congregations for the uninsured.
Within two years after the state passed the country’s first law mandating that people obtain insurance or face a tax penalty, more than 97 percent of residents were insured, the highest rate in the nation. From 2006 to 2008, the proportion of Bay State residents without insurance dropped from 6.4 percent to 2.6 percent. The national rate of uninsured in 2011 was 15.7 percent.
The challenge at the national level of enrolling the tens of millions of uninsured will be much steeper, given the greater public skepticism and political divisions not seen in Massachusetts.
That will make it harder to draw broad support from community and institutional partners like grocery chains and sports franchises, said Jon Kingsdale, former head of the Commonwealth Health Insurance Connector Authority and now a health-care consultant helping other states develop their own insurance exchanges.
McDonough also called upon hospitals, insurers, and drug companies around the country to step up as they did in Massachusetts. Many have signed onto Enroll America’s mission but are not participating in any meaningful way, he said.
“They are in for a dime, and we need them in for a dollar,” McDonough said. “Most of the investments are piddling and not up to the scope of the work that needs to be done. They are overwhelmingly missing in action.”
And politics, too, continues to introduce roadblocks for promoting the law. Earlier this month Republicans on the House Ways and Means Committee subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding to know how taxpayer money is being used for an “Obamacare” public relations campaign.
Stan Dorn, a senior fellow at the Urban Institute Health Policy Center and coauthor of a paper on the secrets of Massachusetts’ enrollment success, recommended that the federal government begin by using the income tax form to jump-start enrollment. More than 86 percent of all uninsured people file federal income tax returns. Many do so for the earned income tax credit and would likely be eligible for subsidized health coverage under the new law.
“Without the Massachusetts experience to guide federal policy makers, we would have no hope,” Dorn said. “Now we have hope, but we also have huge challenges, and I don’t expect the federal effort to be as successful in enrolling people as Massachusetts was.”
Tracy Jan can be reached at email@example.com.