At the New Jersey Policy Forum on Health and Medical Care, on July 12, 2006, invited speakers covered the forces that drove health care reform in Massachusetts and its financing, as well as the important lessons learned and implications for New Jersey.

Our speakers were Michael Doonan, Ph.D.,

“There is no substitute for leadership.”

assistant professor and executive director of the Massachusetts Health Policy Forum at Brandeis University; Victoria Burgess, health policy analyst for the Massachusetts Taxpayers Foundation; and Brian Quigley, regional director of America's Health Insurance Plans. The following is based on Dr. Doonan's presentation.

The lessons from Massachusetts are less about the details of the law (which are covered in the Policy Forum Issue Brief) and more about the people making it happen. Lessons for other states are found in the actions of the people who came together, who compromised and led the way. Massachusetts was the first state to combine individual and employer mandates. In addition, entities were created to ensure and oversee coverage called the Commonwealth Health Insurance Connector and Commonwealth Care Health Insurance Program.

There's nothing like a hanging to focus a person's mind.
The potential loss of 385 million dollars in federal Medicaid funds was instrumental in pushing the reform in Massachusetts. Although it took almost a year and half to pass legislation, "everyone came with their eyes on the prize" and were each willing to give up a little if the end goal was good for everybody.

There is no substitute for leadership.
In particular, Governor Romney, Senate President Travaglini, Speaker DiMasi and The Blue Cross Blue Shield of Massachusetts Foundation demonstrated significant leadership, while a strong grass roots coalition helped advance the process.

Bipartisanship is essential with strong majorities.
With strong majorities supporting polarized agendas, interest groups must be in involved in the process. What's more, it's essential to build on the existing base of coverage.

Sustained progress requires mandates.
All states in some sense are pouring water into a leaky bucket. This is due in part to increasing costs while employers drop coverage. In Massachusetts, government was picking up what business had been dropping over the last decade. Mandates were required to maintain the balance between individual coverage and the requirement that businesses contribute to the solution.

Don't let the best become the enemy of the pretty good.
Polls show that Democrats, Republicans and Independents support universal coverage, but they can't agree on the best way to do it. As a result, everyone's second best idea has been to do nothing. In order to break the gridlock, Massachusetts didn't go for 100 percent coverage, but rather 90-95 percent. And everyone had to give up something.

The devil is in the details.
Massachusetts continues to work out the details of the law and some aspects could prove challenging. Will the current financing generate sufficient funds to sustain the program? Will premiums be affordable for moderate-income people? What will the actual insurance plans cover or cost? No one knows yet, but Massachusetts is hard at work on the answers.

What can be replicated?

Access First
Massachusetts chose to focus only on access, with quality improvement initiatives and cost reduction to come later. The choice was made to focus on one thing, because if everything is the focus, nothing gets done.

Shared Responsibility
Key to the Massachusetts reform is the concept of shared responsibility - by individuals, businesses and government.

Mandates
The individual mandate requires everyone over 18 who can afford health insurance to buy it. The employer mandate requires every employer with more than ten employees to pay an assessment of $295 per employee per year if they don't provide insurance for employees. This assessment is expected to go down as more workers are covered. The employer mandate is expected to generate about the same amount of money as the state spends on health care for uninsured workers. Government will use some of the "free-care" pool funds to help subsidize insurance for low-income individuals. And the legislation includes measures to help make insurance more affordable.

For more information:
Read the issue brief, Universal Health Care in Massachusetts: Implications for New Jersey, by Eileen O'Donnell. Download the 19-page pdf.

Click here for a list of Health Policy Forums and related issue briefs by topic.

Download these pdf handouts from presentations at the New Jersey Policy Forum, July 12, 2006:

• Massachusetts Health Care Reform - Process, Politics and Policy, by Michael Doonan
• Financing Health Care Reform, by Victoria Burgess

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