WASHINGTON -- Universal healthcare, an issue the White House and Congress have largely abandoned since the early 1990s, has reemerged as an issue on Capitol Hill and around the country, with lawmakers looking to Massachusetts' landmark plan as a political and structural model for the nation's 46 million uninsured.
Healthcare specialists and government officials across the political spectrum say the healthcare debate has reached a turning point, with both liberals and conservatives ready to compromise.
Liberals are setting aside old demands for a single-payer system, while conservatives are showing a willingness to consider more government involvement in the provision of healthcare.
With Massachusetts Governor Mitt Romney, an architect of the state's plan, mulling a presidential run in 2008, healthcare is likely to be a big topic in the both the GOP and Democratic presidential primaries, party officials say. The attention the Massachusetts plan is getting in individual states, especially Iowa, the site of the nation's first presidential caucuses, is also pushing the healthcare issue to the forefront.
Senator Edward M. Kennedy , Democrat of Massachusetts and the incoming chairman of the Senate Committee on Health, Education, Labor and Pensions, said he will call hearings in the new Congress to explore using the Bay State plan as a national model.
And some Republican senators think the plan might help US companies compete in the global market by easing the burden of rising healthcare costs. Representative Edward Markey , Democrat of Malden, said he will push for similar hearings in the House.
"It's a conspiracy of the left and the right," said Ed Haislmaier , a healthcare specialist with the conservative Heritage Foundation. Haislmaier has been to different states promoting the Massachusetts approach, which requires residents to obtain health insurance, imposes an assessment on employers who do not provide it, and creates a private taxpayer-subsidized plan to cover people who cannot afford insurance.
Dr. Irwin Redlener, a member of the Clinton healthcare task force in the early 1990s, said the status of the uninsured -- including the growing number of uninsured people and the burdens they impose on hospitals and government programs -- has forced old political foes to work together on a different approach.
"I think, over the years, it's become clear to me that we can't keep waiting for the ideal," said Redlener, president of the Children's Health Fund and Children's Hospital at Montefiore in New York. "We have to be a lot more innovative if we want to get this done in the United States."
John McDonough , executive director of Health Care for All, a Boston-based advocacy group, said two dozen states are seriously considering universal healthcare plans patterned after the Massachusetts program. He called that a stunning response, considering the potentially high price of copying the Bay State plan, especially in states with higher numbers of uninsured citizens than Massachusetts.
Iowa lawmakers recently drafted a bill for universal healthcare inspired by the Massachusetts plan, and New Jersey legislators are preparing legislation with a mandatory insurance provision for residents. State Senator Richard Moore, Democrat of Uxbridge, has traveled around the country at the invitation of lawmakers to describe the Bay State model.
"Because Massachusetts took the initiative and said everyone is going to be insured, it is now the model that other states are going to follow and should follow. That's what we're going to follow," said state Senator Jack Hatch , a Des Moines Democrat who heads the Iowa Senate's health and human services budget committee.
Officials say the issue will be featured in the 2008 presidential campaign debate as well. Healthcare was a pivotal issue in the 1992 presidential race, and after winning office, President Bill Clinton assigned his wife, Hillary Rodham Clinton -- now a Democratic US senator from New York and a potential 2008 presidential candidate -- to head a task force to prepare a national plan.
The package failed in a bitterly partisan Capitol Hill fight, and Congress has not taken up the issue on a grand scale since then. But with the number of uninsured rising yearly, candidates will be forced to discuss the Massachusetts plan as a possible solution, lawmakers said.
Because Iowa is an early caucus state, Hatch said, "we're not just going to be asking [candidates] how [they] feel about it. We're going to be asking how you can help Iowa and other states do it."
Some small businesses and insurers are wary of the plan, said Merrill Matthews , director of the Council for Affordable Health Insurance, which opposes most government mandates on healthcare because of the high costs. But "the country's in a mood now to just do something" about the uninsured, he said.
Congressional hearings to examine the plan, though proposed by Democrats, would probably boost Romney's profile and add to his credentials at a time when the governor is exploring a presidential bid, Democrats acknowledged. But Moore and others said the issue itself was too important to subject to political warfare.
Kennedy said the Massachusetts plan would not work everywhere because states have vastly different demographics and healthcare problems. But the idea of state-run programs to cover nearly all of the uninsured was catching fire, he said.
"If you look at [mandatory] auto insurance, the first state to have it was Massachusetts," Kennedy said in an interview. "It set the example for the nation," and Massachusetts' bipartisan plan could do the same for healthcare, he said.
Hearings would focus on what states and the federal government can learn from the Massachusetts plan, but are not meant to push a uniform, national program, a Kennedy aide said.
The federal government must approve such approaches as the Massachusetts plan by providing a waiver, even if the idea doesn't cost the federal government more money. Because Medicaid, a federal program, is part of the Massachusetts approach, the federal government has an interest in any plan that follows the Bay State model, McDonough said.
Senator Trent Lott , a conservative Mississippi Republican and a newly-named member of his party's leadership, called the Massachusetts plan "a good idea," and said he wanted to examine what parts of the program could be used elsewhere in the country.
Senator Jeff Sessions, Republican of Alabama and a member of the HELP Committee, said, "It has aspects I'm interested in. I think it merits some examination."
Timothy R. Murphy , Massachusetts secretary for health and human services, said he has been swamped with requests from other states to discuss to Massachusetts plan, and has already been to Minnesota, California, and Missouri.
Moore recently outlined the program at a conference in Texas of the National Council of State Legislatures, and said he has been approached by a member of the Irish Parliament as well as a foreign ambassador who were interested in the idea.
"Massachusetts is going to do one flavor of healthcare reform, and other states are going to look and do something that fits their needs," Murphy said. "Maybe there is a broad national application" of the program, but at least, "we clearly have reignited the healthcare debate across almost every state capital," he said.