THE TREATMENT JANUARY 19, 2010
Scott Brown's campaign has been arguing, directly and indirectly, that national health care reform would be bad for Massachusetts, since the state enacted its own, very similar version of reform three years ago. As Brown adviser Eric Fehrnstrom told Politico's Ben Smith
In Massachusetts, 98% of residents are covered by insurance through our own state reforms. The plan is not perfect, and we need to get costs down, but we have already achieved near-universal coverage. There is nothing for us in a national plan except higher taxes and more spending to finance coverage expansions in other states. It's a raw deal for Massachusetts
But is that really the case? I put the question to Michael Miller, who is the policy director for Community Catalyst, a national health care advocacy group based in Boston. Here's what he told me:
It's complicated. On the one hand, if you look at the funding sources we are likely to see in the bill--tax on high cost plans, tax on unearned income and some of the drug industry and other provider savings--you would expect Massachusetts to make a contribution above say what Mississippi puts in. (This to me seems like a perfectly appropriate thing for a federal government to require--generally having more affluent folks pick up some of the tab so lower income folks can get health insurance and health care. If they could afford it themselves they wouldn't be uninsured to begin with.)
On the other hand, Massachusetts gets a lot of extra federal money right now to support its health care coverage experiment and both the House and Senate bills, through somewhat different mechanisms, include language that would keep that money flowing and add to it (e.g. by extending subsidies up to 400 percent of the poverty line, enhancing Medicaid payments and/or preserving Medicaid Disproportionate Share dollars. [DSH money, as it's known, helps subsidize charity care for the uninsured.]
Also, you could argue (and I would argue) that health reform in Massachusetts is more likely to survive in the long run if it is part of a national program of (near) universal coverage rather than as an island. So to the extent that you see Massachusetts reform as a good thing, and I do, then federal reform is good for Massaachusetts.
Finally, as a high cost state, Massachusetts residents could potentially be the beneficiaries of strategies that make health care more cost-effective over time.
Bottom line--I haven't tried to do the math and I doubt the Brown campaign has either and if they did, I doubt it was a very fair assessment. Massachusetts residents may pay something so that low-income people in other parts of the country can get health care, but so what? To call this a problem with reform is at best extremely parochial. If you're going to insist that every state entirely self-finance the cost of caring for the uninsured who happen to reside within state borders, where do you stop--with secession?
Doesn't really fit too well on a bumper sticker or robo-call though, does it?
Community Catalyst is a progressive organization, obviously, but they are also the go-to source on everything related to health care in Massachusetts. And this analysis seems sound to me.
Besides, Miller doesn't even mention the fact that Massachusetts, along with Vermont, would receive extra funding under the Senate bill, precisely so it's not penalized for having expanded coverage on its own. (I wrote about this yesterday.)
By the way, for more background on how health care reform nationally would affect different states, the Washington Post's Alec MacGillis wrote about the issue way back in May, before most of us understood what a big deal it would be.