Watching the disastrous rollout of Obamacare makes you wonder how we ever managed to pull off the Massachusetts universal health insurance plan that became the national model.
Everyone knows about the serious problems dogging the federal Affordable Care Act — the online service that didn’t work and the cancellation of existing coverage President Obama had promised people would be able to keep. You can bet your last Band-Aid there are more “glitches” to come.
Of course, Obamacare is vastly larger and more complex than reform plans enacted in Massachusetts seven years ago. But, looking back, didn’t it seem as though everything went off relatively smoothly?
Well, it didn’t. The state law mandating near universal health coverage — and many of the details — were a tangle of big problems and nagging complications. The system still has issues, many years after enactment.
The important point: The way most of those problems were solved in Massachusetts is not encouraging for the president. The crucial resource turned out to be an almost unprecedented degree of cooperation and compromise. Good luck finding much of that in Washington.
I’m not just talking about Mitt Romney, the Republican governor, and Democrats in the Legislature who found enough common ground to pass the law in the first place. Business interests and the people behind them, like Rick Lord of Associated Industries of Massachusetts, reached compromises with advocates like John McDonough, then executive director of Health Care For All, and Celia Wcisio of the Service Employees International Union. Executives at hospitals and insurance companies also reached common ground.
These were the people and organizations — commonly opponents — that really ironed out policy issues and technical problems to turn an idea into a functioning system.
“It had every opportunity to fail in implementation, as laws often do,” says Michael Widmer, the fiscally conservative president of the Massachusetts Taxpayers Foundation, another one of those people at the table in the early days. “The fact that the program has held together over almost a decade now, and through the worst recession in anyone’s memory, is a stunning achievement.”
One example: Defining the minimum amount of coverage an insurance policy must offer for it to be deemed acceptable in Massachusetts. This is the same issue that helped undermine Obama by prompting the cancellation of some existing policies.
The state universal health law left that decision and other important choices up to directors of the Massachusetts Health Connector, an entity formed with the mission of putting the legislation into action. The final vote on what a health policy must cover was a compromise that came with the mandated drug coverage advocates wanted and the high-deductible options business sought.
“Getting the bill passed was one thing, but it could have gone awry in implementation, and the Connector board played an important part,” Lord says.
The Massachusetts experience also came with tight deadlines and technical challenges. Sometimes, services arrived months late. “No one in the advocacy community said boo,” recalls Jon Kingsdale, the Connector’s original executive director. “It was just accepted.”
I’m not saying universal health care made it in Massachusetts on Kumbaya alone. When money got tight, federal subsidies in the form of Medicaid waivers were critically important. The starting pool of uninsured state residents — less than 10 percent of the population — was relatively small and easier to shrink than the national numbers. And public opinion was solidly in favor of the law. Compare that with Obamacare poll numbers.
But I got the feeling an important lesson from the recent past had been lost, or ignored, when the president came to Boston three weeks ago. Obama flew into town hoping to revive support for his most important accomplishment with a high-visibility celebration of its Massachusetts roots (managing to get upstaged by Game 6 of the World Series).
The event had the look and feel of a partisan political rally, utterly contrary to the sensibility that made the Massachusetts experiment successful. Talk about missing the point.
But the Affordable Care Act doesn’t enjoy the benefit of goodwill among adversaries. It still faces opponents thrilled to seize upon every misstep as an opportunity to kill a law they hate. Those are dangerous obstacles.
Obamacare may recover and win more support once people see benefits. I’m not sure the Massachusetts reforms that inspired it could have survived the same stiff resistance.