Transcript for the Piece Audio version of Health Reform Part 1 -- How Massachusetts' health reform was passed

THIS SUMMER, THE OBAMA ADMINISTRATION INTENDS TO RELEASE ITS NATIONAL HEALTH REFORM PLAN – EXPECTED TO BORROW HEAVILY FROM MASSACHUSETTS’ EXPERIENCE. IN 2006, MASSACHUSETTS BECAME THE FIRST STATE TO REQUIRE EVERYONE TO HAVE HEALTH INSURANCE, AND IT HELPED PAY FOR HEALTH CARE FOR THOUSANDS MORE PEOPLE. WFCR'S KAREN BROWN HAS BEEN REPORTING ON THE LAW AS PART OF A KAISER FOUNDATION FELLOWSHIP. TODAY, SHE STARTS A 3-PART SERIES, WITH A LOOK BACK.

A LOT HAS HAPPENED IN MASSACHUSETTS SINCE THE REFORM LAW PASSED IN 2006. FOR ONE, THE ECONOMY TANKED. THOUSANDS OF RESIDENTS HAVE LOST THEIR JOBS AND WITH THEM, THEIR HEALTH INSURANCE. AT THE SAME TIME, A PLUNGE IN TAX REVENUES HAS PUT TREMENDOUS STRAIN ON THE STATE BUDGET.
DESPITE THE CRISIS, 440,000 MORE PEOPLE HAVE HEALTH INSURANCE THAN BEFORE THE LAW. THE STATE HAS THE LOWEST UNINSURED RATE IN THE COUNTRY – 2.6 PERCENT. BUT WILL THE STATE’S EXPERIMENT GET STRONGER AND BECOME A NATIONAL MODEL? OR WILL IT BUCKLE UNDER BUDGET AND POLITICAL PRESSURE?
MCDONOUGH: this is not like driving a car across Kansas, where you are on a single straight road that goes forever & you can see all the way up to the horizon.
JOHN MCDONOUGH – NOW AN AIDE TO SENATOR TED KENNEDY – HELPED WRITE THE MASSACHUSETTS HEALTH LAW. WHEN IT PASSED, HE WAS HEAD OF THE CONSUMER GROUP, HEALTH CARE FOR ALL. WHILE IT MAY HAVE SEEMED LIKE A GIANT LEAP, MCDONOUGH SAYS THE PROCESS WAS MUCH MORE INCREMENTAL.
MCDONOUGH: the 2006 law was the 8th significant statute since 1985. And just about everything done in the 2006 law builds those 7 prior statutes.

FOR INSTANCE, IN THE 1980S, THE DUKAKIS ADMINISTRATION PASSED A LAW REQUIRING EMPLOYERS TO PROVIDE HEALTH INSURANCE, BUT THAT FELL APART UNDER POLITICAL PRESSURE. THEN THE STATE CREATED THE FREE CARE POOL -- A LARGE FUND OF STATE AND FEDERAL MONEY TO PAY FOR PEOPLE WHO SHOWED UP AT HOSPITALS OR CLINICS WITH NO INSURANCE. IN THE 90S, THE STATE EXPANDED ITS MEDICAID PROGRAM TO INCLUDE MORE THAN 300,000 ADDITIONAL PEOPLE. ALL THIS WAS IN PLACE WHEN GOVERNOR MITT ROMNEY AND THE LEGISLATURE STARTED TO HAMMER OUT THE LATEST REFORM LAW.
MCDONOUGH: we started w/ a lower 0:26:44.9 number of uninsured than most other states & we started w/ more robust federal financial participation than most other states. so we were able to go to … the feds & say to them listen, you don't have to give us new money just let us redirect this existing money in our system. [& we'll lead to a much better outcome for people.]
IT WAS ALSO ABOUT THAT TIME THAT THE FEDERAL GOVERNMENT WAS THREATENING TO REDUCE THE AMOUNT OF MEDICAID MONEY IT GIVES MASSACHUSETTS BY ABOUT 750 MILLION DOLLARS A YEAR -- UNLESS THE STATE COULD SHRINK ITS UNINSURED POPULATION. THAT’S WHEN A VARIETY OF STAKEHOLDERS -- INSURERS, BUSINESSES, ADVOCATES, LEGISLATORS -- JUMPED INTO THE DEBATE OVER HOW TO BRING THE NUMBER DOWN. AND THERE WASN’T IMMEDIATE CONSENSUS. FOR INSTANCE, CONSUMER ADVOCATES WANTED MORE PRESSURE ON EMPLOYERS TO PROVIDE INSURANCE. BUT THE BUSINESS LOBBY PUT ITS FOOT DOWN. RICHARD LORD IS PRESIDENT OF THE ASSOCIATED INDUSTRIES OF MASSACHUSETTS.
Lord: we supported the goal of providing universal coverage. …0:04:22.4 … but our interest was to make sure that whatever was done didn't' necessarily or overly burden the business community here. b/c MA is a pretty high cost state to begin with. [& we didn't want to put our members at a competitive disadvantage. ]

IN THE FINAL LAW, MEDIUM AND LARGE EMPLOYERS WHO DON’T CONTRIBUTE AT LEAST 30 PERCENT TOWARDS WORKERS’ INSURANCE ONLY FACE A SMALL PENALTY -- $219 PER WORKER. JON KINGSDALE RUNS THE STATE’S CONNECTOR BOARD, WHICH OVERSEES HEALTH REFORM. HE POINTS OUT THAT BUSINESSES HAVE COVERED MORE THAN 150,000 NEW EMPLOYEES SINCE THE LAW PASSED.
Kingsdale: Which says to me that, the combination of the individual mandate, which motivated many employees to take the offer frm their employer…, and motivated some employers to newly offer insurance to employees, and capped a very very high level of employer support for this overall health reform, was a pretty good balance.

FOR PEOPLE WITHOUT JOB BENEFITS, THE STATE CREATED THE COMMONWEALTH CARE PROGRAM, WHICH GIVES FREE OR SUBSIDIZED INSURANCE TO THOSE MAKING UP TO THREE TIMES THE FEDERAL POVERY LEVEL -- ABOUT 32,000 DOLLARS A YEAR. IRONICALLY, IT’S THE POPULARITY OF THIS PROGRAM THAT’S CREATED THE BIGGEST FINANCIAL HEADACHE FOR THE STATE; IT’S BUDGETED AT CLOSE TO A BILLION DOLLARS A YEAR, ABOUT DOUBLE FROM WHERE IT STARTED. ANDREW DREYFUS -- VICE PRESIDENT OF BLUE CROSS BLUE SHIELD OF MASSACHUSETTS -- SAYS AUTHORS OF THE HEALTH REFORM LAW MADE A CONSCIOUS DECISION TO INSURE PEOPLE FIRST, AND WORRY HOW TO PAY LATER.
Dreyfus: And the reason for that was, in other efforts around the country, both nationally & locally, when people had tried to expand coverage, it had always gotten stuck. Cuz people say we can't move forward until we solve the cost problem. & the coverage issue had been held hostage & so no progress had been made.

SOME CRITICS OF MASSACHUSETTS-STYLE HEALTH REFORM, HOWEVER, AREN’T SURE IT IS PROGRESS. MANY ARE ADVOCATES OF A SINGLE-PAYER SYSTEM, IN WHICH THE GOVERNMENT – THROUGH TAXES – WOULD COVER EVERYONE AND CUT OUT INSURANCE COMPANIES ENTIRELY. BUT JOHN MCDONOUGH SAYS IT WOULD BE NAÏVE TO HOLD OUT FOR THAT – ESPECIALLY ON A NATIONAL LEVEL.
MCDONOUGH: everyone has there perfect vision of how the world should be & how it should look. & then everybody's second choice is the status quo. ...
NANCY TURNBULL, A HARVARD PUBLIC HEALTH PROFESSOR WHO SITS ON THE CONNECTOR BOARD, SAYS THERE IS MORE WORK TO BE DONE IMPROVING THE HEALTHCARE SYSTEM.
TURNBULL: it's been i think very successful in terms of really expanding coverage, on reducing the rate of insurance, but there's still too many people who are uninsured. there's not affordable coverage available for everyone. ... 0:16:29.2

IN THE MEANTIME, INSURANCE PREMIUMS – FOR EMPLOYERS, INDIVIDUALS, AND GOVERNMENT -- ARE GOING UP BY MORE THAN TWO OR THREE TIMES THE RATE OF INFLATION, AND THE NUMBER OF PEOPLE NEEDING HEALTH INSURANCE IS CLIMBING HIGHER EVERY DAY. FOR WFCR AND WNNZ, I'M KAREN BROWN.