Universal Health Care in Massachusetts: Setting the Standard for National Reform

I. INTRODUCTION Health care reform in the United States has proven to be one of the most complex challenges facing lawmakers and private citizens today. Although there is widespread agreement that the system is in disarray and in dire need of fundamental reform, the core problems of affordability and access continue to steadily worsen. The extent of the national health care crisis is reflected in the fact that although health care annually consumes some sixteen percent of the nation's GDP (or $2.0 trillion), (1) 46.5 million Americans under the age of sixty-five are currently uninsured. (2) Notwithstanding the astronomical resources devoted to health care, the number of uninsured nationwide is expected to rise if skyrocketing costs and other barriers to access are not systematically addressed. Despite this national crisis, the country's political and economic leadership continues to debate while avoiding any real action. Compounding the lack of political consensus and will is the specter of record budget deficits as a considerable road block to systemic reform. (3) Facing this dearth of national leadership, a growing number of states, including Vermont, Wisconsin, and California, are undertaking health care reform at the state level. Of all the state reforms, none has received more attention than Massachusetts' newly enacted health care reform law. This landmark legislation entitled, An Act Providing Access to Affordable, Quality, Accountable Health Care (the "Act"), was passed on April 12, 2006. (4) Having taken effect on July 1, 2007, it is to date the boldest plan for achieving universal coverage, especially with its aggressive timetable of being fully implemented in just three years. (5) The plan has garnered much attention for its innovative design, but is equally noteworthy for the political process behind the plan's adoption and implementation. In early 2006, a broad-based coalition of over eighty private and public interest groups teamed with a Democratic state legislature and a Republican governor to enact the most comprehensive state health care reform bill in the nation. (6) That such a disparate group of supporters agreed to any state-wide health care reform proposal is remarkable. Even more impressive, however, is that such depth and breadth of support have coalesced for a plan that is largely untested. Given the profound importance of achieving universal coverage and the political and financial stakes involved, all eyes are on Massachusetts. The nation waits to see what lessons will unfold from a plan which may or may not be practically feasible and economically sustainable. No one, however, is watching more intently than the people of Massachusetts, whose lives may hang in the balance. The new law seeks to provide universal health care coverage to all residents of the Commonwealth. (7) Its key provisions mandate coverage, emphasize personal responsibility, and create incentives for employers, particularly small businesses, to provide insurance. It also reorganizes the insurance market to foster competition and choice, and expands subsidized assistance without raising taxes. (8) This Article examines the plan's strategy for achieving its fundamental objective of providing all residents with universal access to affordable, quality, and accountable health care. Part II begins by describing the health care challenges that have confronted Massachusetts given the Commonwealth's fiscal and political climate as well as its demographic make-up. It then analyzes the plan's primary components, paying particular attention to the costs and benefits of expanding Medicaid coverage, the use of health care mandates, and the newly-created Commonwealth Health Insurance Connector Board (the so-called "Connector"). The extent to which the Massachusetts Health Care Plan can achieve its goals is discussed in Part III, especially in light of what has proved to be the bane of even incremental state reform for too many years: ERISA preemption of state law. …