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Bay State model for national health care works

October 14, 2012 12:10 am


Mitt Romney (right) stands with Ted Kennedy (center) and Timothy Murphy after signing into law 'Romneycare.'

MORE VIRGINIANS are finding themselves concerned about the future of health care now that it is playing a prominent role in both our presidential and senatorial elections. Although the economy is the major issue, health care is a close second. As a former resident of Massachusetts who has closely followed the development of the Affordable Care Act, I believe the Massachusetts model has significant merit for success on a national basis.

The ACA formulated by President Obama and a cadre of health professionals passed Congress in 2010 and was constitutionally confirmed by the Supreme Court in 2012. Because the ACA is quite complex and has not been disseminated in a simplified form, people have considerable anxiety about how it will affect them. As citizens have become more educated via community agencies, the Internet, and print media, their anxiety has diminished. The Boston Globe has provided extensive public service information about the early development of the Massachusetts ACA through the present.

In 2005, Gov. Mitt Romney realized the need for action in Massachusetts because of the spiraling cost of health care. Romney and his advisers posed the question: "Should adults with sufficient income be required to buy basic health insurance or pay a penalty if they refuse?" This focused on the theme of personal responsibility, a basic conservative idea.

A political adviser pointed out to Romney that a huge number of people in Massachusetts were going to the emergency room at costs that were four or five times the amount charged by a physician's office. Romney remarked that "this was wrong because they were passing along the costs of this care to others."

Gov. Romney came to accept that if younger, healthier people were brought into the system the cost of premiums would decrease. Later, Romney told reporters "there would be no more free riders where the individual says he is not going to pay even though I can afford it." Such action was against the conservative maxim not to look to government to take care of them if they can afford to take care of themselves.

After discussion over a two-year period among Democratic and Republican politicians, with the support of the late Sen. Ted Kennedy--which was crucial--the landmark legislation was signed into law on April 12, 2006. Thus, Massachusetts became the first state to impose an individual mandate and set up a model to provide universal health care for all of its residents. President Obama modeled his ACA on the Romney plan, but included numerous revisions. But Romney, the Republican presidential candidate, does not support most of the new reforms.


The interesting question in 2012 is: How has the plan worked? When the ACA was passed by Congress, several benefits and restrictions were added. Among the many benefits, the popular ones include: There will no longer be discrimination for pre-existing conditions; adult children will have coverage on their parents' policy to age 26; and no longer will there be any lifetime or annual benefits caps on health insurance.

The Boston Globe (Sept. 26) reports a long list of benefits of the Massachusetts ACA, of which the following are noteworthy:

Massachusetts now has 98 percent of its population covered by the ACA; penalties are applied to those who do not elect coverage, with a tax that varies but is significantly less than the average cost of an emergency room visit.

There have been millions of dollars in savings from a substantial decrease in emergency room visits and more reliance on Health Exchanges.

The ACA now holds insurance companies liable for the 80/20 rule, which requires that families receive a rebate if the company fails to spend at least 80 percent of its premiums on health care services. Massachusetts residents will receive approximately $12 million in rebates in 2012.

This year the ACA has saved seniors more that $76 million on prescription drugs in the doughnut hole coverage gap that will soon be closed. The average Massachusetts resident with traditional Medicare will save $5,000 per year, and those with high prescription costs will save even more.

Health Exchanges will be set up beginning in 2014 to enroll 30 million of the 50 million people who now have no health care.

There will be new funding for Community Health Centers and the National Service Corps to improve the supply of primary care services.

Provisions will be enacted to block health care fraud and abuse in Medicaid, Medicare, and private insurers.

Analysis of ACA expenditures by the Congressional Budget Office indicates that ACA will reduce the federal deficit by about $140 billion over 10 years.


Massachusetts, with 98 percent participation, insures a good mix of young and old adults, which will maximize the enrollment and provide the necessary funds to help sustain the program.

Furthermore, the 98 percent participation in the Massachusetts model is clear evidence of its popularity. My conviction that it is a success was confirmed after talking with several Massachusetts friends and relatives, and consulting local news sources. The only dissatisfaction was with health care costs, which clearly must be reduced.

From a scientific perspective, I believe the six-year Massachusetts experiment has been successful and the model is realistic. Does it need more work? Absolutely. Although health insurers have lowered premiums, health costs remain too high and not transparent to the consumer.

However, as found in the Massachusetts model, the key to sustainability is to maximize participation, to support the conservative principle of individual responsibility, and to penalize those who don't participate with a tax. Divergent constituencies in any state must demonstrate leadership and not be afraid to compromise for the good of the people.

Fifty million people lack health care and look to employers, health providers, and the government for help. Congress and the president must compromise for the good of Americans to make the ACA work and be productive for years to come.

Bernard Mahoney is distinguished professor emeritus, the University of Mary Washington.

Copyright 2014 The Free Lance-Star Publishing Company.