April 12, 2006 marked a historic day not only for the people of Massachusetts but also for state and federal policymakers and the national populous as a whole. On the aforementioned date, Mitt Romney, then governor of the commonwealth of Massachusetts, signed into law the Massachusetts Health Reform Bill. According to John Holahan, director of the Health Policy Center, Urban Institute, in Washington D.C., “the essence of the legislation is a mandate that everyone in the state have health insurance if affordable coverage is available.” (2006) On April 12, 2006 Massachusetts had passed a milestone on a very ambitious and hereto unprecedented journey to provide health insurance to virtually all of its constituents.

Massachusetts makes a logical proving ground for progressive health reform initiatives to be tested. For the better half of the last century, the state has been represented by Sen. Ted Kennedy who has been and continues to be a longtime champion for health reform. His consistent validation at the polls every six years makes it no surprise that 92 percent of the generally population in Massachusetts believes that health care is a right. (Blendon, 2008). However, it would be a mistake to consider the passage of legislation of this nature to be a slam dunk for policy makers and advocates- as history shows it was not. Many consider advocating for universal health care to be analogous with the democrat party policy and platform, but as many may recall from the 2008 presidential elections, Mitt Romney is a republican. Interestingly the federal government by threatening to reduce the amount of funding it was providing to Massachusetts for an expanded Medicaid program and the imminent possibility of a ballot measure directing the state to create a universal health program forced the hand of interested parties statewide to sit down and hammer out a compromise toward that end. (Blendon, 2008). As one might expect there was the usual disagreement as to the particulars of what should be covered, who should be covered, how the coverage should be implemented, and of course, who is going to pay for the bill.

In the end, the legislation had several key parts, some more germane than others. For instance, under the individual mandate the people of Massachusetts were coerced to buy health insurance or pay a penalty in state income tax. This was deemed the only practical way to enforce the new law requiring residents to carry health insurance. While it is true the population in Massachusetts leans more democrat than republican, direct infringement on federally constituted rights is not necessarily easy to swallow for everyone. This specific example has been and continues to be the sticking point amongst the Massachusetts population with only a slight majority approving. Despite this, it should be noted however that over 90 percent of the population believes that the bill is “the right thing to do” and there is virtually no support for its repeal. (Blendon, 2008). Other less controversial measures contained within the legislation include the expansion of programs designed to allow individuals to pay for individual coverage at small group rates and through tax free dollars, the creation of the health connector which aimed to provide low income groups with pre-negotiated, sometimes subsidized health plans, and support and guidance for employers who previous struggled to or did not provide insurance for their workers. (Holahan, 2006)

As stated earlier the plan had and continues to have great support amongst the general population as it gains almost double digit ground in the approval rating each year. A key point of interest however concerns the fact that amongst groups which are believed to be the most effected by the new legislation, that is lower socioeconomic status, the legislation has somewhat less appeal. Many constituents are concerned that the affordability of health insurance is inherently oxymoronic to their situation and the bill has hurt rather than helped them. (Blendon, 2008) Focusing on affordability continues to be a topic of conversation for future revisions in order to make the legislation more practical as well as to avoid public backlash leading to possible ballot initiatives to derail it.

With all the chatter amongst the public, interest groups, and policy makers currently surrounding the creation of something similar on a national level, interested parties would be wise to study the process by which Massachusetts has accomplished its goal. While it’s too early to tell the full extent to which this legislation will work or fail and thus not a case study to roll the entire U.S. Treasury on, the young Massachusetts experiment can serve as an excellent template for policy implementation.

Blendon, Robert J, et al. (28 October 2008) Health Affairs 27, no. 6 (2008): w-556-w565 (published online 28 October 2008)

Holahan, John, et al. (14 September 2006) Health Affairs 25 (2006): w432-w443

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