REPRESENTATIVE STEVE WALSH SLEPT FOR WEEKS IN HIS SON’S ROOM at Boston Children’s Hospital on a padded window bench that was inches too short for his 6-foot-3 frame. Myles, a twin with a heart defect, had been rushed to surgery — the first of several — hours after he was born on March 24, 2011. Until Myles was ready to go home, Walsh showered and dressed at the hospital and conducted House business from his phone and laptop between doctors’ rounds. He commuted by Green Line to Beacon Hill or was shuttled back and forth by his staff.
Shortly before the twins’ arrival, the 39-year-old Democrat from Lynn had been named the House leader of a legislative committee with a massive task: find a way to slow escalating health care costs that threatened to swallow much of the state’s budget. And do it without undermining the core of the Massachusetts economy. The governor had proposed a framework for a bill, and, as spring approached, the House was under pressure to act. After Myles and sister Maeve arrived, Walsh told Speaker Robert DeLeo that he would step aside if there were any doubts, given his son’s illness, about his ability to continue in what would be an all-consuming job. The speaker kept him on. “I’m going to take credit for that,” DeLeo says now, “for making him my starting pitcher and my closing pitcher, as well.”
After nearly 18 months of deliberation in the Legislature, Governor Deval Patrick signed a law in August that once again put Massachusetts in the national spotlight on health care. The state became the first to set a limit on spending by doctors and hospitals, holding increases to about the growth rate of the overall state economy, or half what they had been in recent years. And Walsh, a relative newcomer to health care policy, was a lead writer, credited as a strong voice for consumers — “the people’s legislator,” one adviser said — who was willing to make industry leaders uncomfortable as he pushed for aggressive measures.
Walsh’s experience with his son strengthened his commitment to the work, those close to the debate say. Walsh met with leaders of the hospitals in the Longwood Medical Area, often walking to their offices from his son’s room at Children’s. He listened to stories from parents of other sick children shared at night over drinks at a bar nearby, and he asked tougher questions of Myles’s doctors, he says. Political leaders were eager for a plan to relieve the state budget and protect the nearly universal insurance coverage achieved under a 2006 law that became a model for the nation. For Walsh, one of his priorities was to help the state’s beleaguered community hospitals so that health care grew less expensive and Boston’s world-class facilities remained accessible when families, like his, needed them. The job “was more important than ever,” Walsh says. “I was living it.”
During high school, Walsh began washing cars at Cuffe-McGinn Funeral Home in Lynn and did other jobs there through college. Drawn by the role the business plays in a close community, he thought he might make a career of it. Instead, he went on to lead LynnArts, a nonprofit focused on the city’s redevelopment through arts. In 2002, he entered the family business, winning his House seat as he was pursuing a law degree. His father is a lobbyist and his mother a longtime Lynn city councilwoman. He met his wife, then Annie McGlynn, while she was working on Representative Michael Costello’s campaign.
In the State House, Walsh tackled public health issues, including a prescription monitoring program to curb abuse of powerful painkillers, and he was on a conference committee in 2010 for a smaller health costs bill. But none of them matched the job that faced the joint Committee on Health Care Financing, which Walsh led with veteran health care policy maker Senator Richard Moore. Walsh hosted hundreds of meetings with doctors, insurers, consumer groups, employers, and others, aided along the way by a quality that defines his politics: He is unambiguous in his opinions. As the committee launched a series of public hearings in May 2011, Walsh warned those testifying that their concerns did not constitute “a reason to do nothing.” Bring ideas, he said. “You always know what he’s thinking,” says Harvard economics professor David Cutler. “That is his style. I think people ultimately liked it.”
Walsh began meeting weekly with Cutler and colleagues at Harvard, Amitabh Chandra and Jeffrey Liebman. The three have advised presidents and the Congressional Budget Office on health care. Walsh often arrived for their meetings at the Kennedy School of Government or the State House bleary-eyed from long nights at the hospital, but having read all they asked of him and prepared smart questions for the experts. Early on, Cutler says, the group considered this one: If the state did not act strongly to control costs, would it be forced to give up on its commitment to universal coverage? “The answer to that was yes,” Cutler says.
The House and Senate released their proposals in May. Both set targets for spending and pushed providers and insurers into new ways of paying for health care that emphasize prevention, but the House version went farther in its spending limits. Hospitals and physician groups roundly criticized Walsh’s proposal, calling it a threat to health care jobs. The bill was “overly ambitious,” reflecting Walsh’s “inexperience and youth,” says Michael Widmer, president of the Massachusetts Taxpayers Foundation. One provision, in particular — a touch of Robin Hood ethic — drew ire. Walsh proposed a “luxury tax” against the highest-priced providers. The money would be redistributed to struggling hospitals. It was a “crazy concept,” Chandra, the economist, says. But even as Senate leaders made it clear they would not go along with the tax, Walsh held on.
When the bill was finalized in July, the lawmakers had reached a middle ground on the spending target and the tax was gone. Instead, the bill included funds for preventive care and health care technology, also Senate priorities, and a one-time surcharge against all hospitals and health plans that have more than $1 billion in assets and less than half of their revenue from public programs. The charge is expected to raise $135 million for distressed community hospitals to make changes to keep up with the market. “From the get-go we were playing chess,” Walsh says.
Walsh has been traveling in recent months to conferences around the country for legislators and trade groups, giving speeches about how the bill was made. He’ll put that work on hold for awhile. Myles, now a gentle-mannered toddler, will be a big brother soon, as the Walshes are expecting their fourth child. Meanwhile, an 11-member board stacked with nationally renowned health care experts — Cutler among them — and responsible for putting the law into action began its work in November, with heavy expectations.
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