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Sep 10 2009, 2:42 pm by Marc Ambinder

RomneyCare: It's Working (Mostly), And It's Popular (Largely)

The nation's most ambitious experiment in universal health insurance is succeeding on its own terms, and has become fairly popular, a new survey minds. 96% of working age adults have health insurance in the state today, which is significantly higher than the national average. Also up: the percentage of people with private health insurance. It's now as high as 70% among seniors. An Urban Institute study finds that 72% of state residents are happy with the effort. The Massachusetts plan included an individual mandate, required employers to either provide coverage or pay into an insurance pool, expanded Medicaid and created a new government health care program for the lower middle class, and created a health connector agency that matches individuals with the private plan of their choice. About half of those who enrolled in the new programs are now covered by government-run plans.

In calling it RomneyCare, I'm continuing the tradition of identifying the health care program by the chief executive who signed it into law. As Romney's health policy advisers will tell reporters, Romney didn't favor the mandate that Massachusetts Democrats added to it -- Romney wanted people who refused to buy insurance to post a bond that would cover their emergency care. But he supported the package in the end. It is something that our all-or-nothing political system doesn't tolerate: a government plan administered by private companies; a mixture of regulation and market incentives. A hybrid. (Remember -- Sen. Edward Kennedy was a major Romney ally.) Compared to other states, Massachusetts had a relatively easy go of it -- its social safety net was generous and the percentage of unemployed persons was lower than the national average to begin with. Critics worried about the program's costs -- it included income subsidies --- and who would bear the brunt of the transferred costs. (Critics say that it has amounted to a tax on the middle class -- technically true, but the middle class seems OK with it.)

The recession has hurt the program's fiscal sustainability; more uninsured residents means that more money is needed to finance the system, and the legislature has struggled to find ways to preserve the same level of service for an expanded pool of people needing insurance. So -- costs remain an issue. But advocates of the plan say that, relative to the past, the state is getting much more bang for its bucks.

Cost containment in the future may rest on the fate of the second phase of reform efforts -- large changes to the delivery part of the system.

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Comments (13)

John Thacker
Critics worried about the program's costs

Critics also worry, more importantly, that much of the costs are subsidized by the federal government (covering extra people under Medicaid, which the Commonwealth does as a result, gets subsidized to a substantial extent). Is the federal government going to be subsidized by foreign countries?

So any reasonable cost numbers have to count the extra federal Medicaid (and other) subsidies that Massachusetts receives for its program. Take that into account, and you have a terribly expensive program that remains popular. Just like Medicare, which Democrats were assuring me was "the real problem" when GWB discussed Social Security.

RobM1981

"Costs remain an issue..." ???

Excuse me for pointing out that it's more than an issue. RomneyCare is bankrupting the Commonwealth.

Against a budget of approximately $28B, Massachusetts is facing a 2009 deficit of over $3B. Considering that 2009 also included so much Federal Assistance, this cannot be explained away simply by the recession.

95% coverage is more than Massachusetts can afford.

Right now the USA has a population of about 310M people, about 30M of whom are unemployed. Maybe as many as 40M, depending upon who you believe.

That means that we, as a nation, are already around 90% - and we are facing devastating deficits approaching $2T per year.

If an affluent state like Massachusetts can't afford even 95% coverage, what makes you think that the whole nation - far less affluent than the Bay State - can afford 100% without destroying the economy?

FMCTandP (Replying to: RobM1981)

@RobM1981

Are you really blindly equating the entire current MA deficit with the cost of RomneyCare?

Do you really understand unemployment numbers so poorly that you believe "unemployed" is just a synonym for doesn't have a job?

Do you really believe that every employed person has health insurance as part of their job?

This strikes me as either appalling, willful ignorance or a deliberate attempt at misrepresenting basic facts in an attempt to convince those who are so ignorant.

Your post reminds me of a statement by Daniel Patrick Moynihan, which I will attempt to recapitulate: Everyone is entitled to their own opinion, but no one is entitled to their own facts.

RobM1981 (Replying to: FMCTandP)

Here, have some facts.

http://online.wsj.com/article/SB121728669884991317.html

Massachusetts cannot afford the plan they are providing. Period.

Comrade Jake

Why does Mitt Romney hate free markets?

BR0CK

How Republicans as a whole ought to utilize the Massachusetts model is by pointing out they both increased coverage (the total figure is 98%) and lowered costs WITHOUT a public option. If the Democrats and Obama are sincere about covering the medically uninsured, then there's no reason to insist upon an aspect they desire when it has been proven entirely unnecessary.

If instead Republicans attempt to adhere to a doctrinalist rejection of any government role in the health insurance industry, then in the long term they will ultimately lose. Tort reform, competition opened up nationally are two elements we also should be promoting.

In terms of Commonwealth Care, there are certainly undesirable elements and imperfections about it, but at just 2% the state budget it by no means is 'bankrupting' Massachusetts. If Governor Patrick and his 85% Democrat legislature cannot figure out how to triage state spending, then obviously the elective composition needs to be improved.

BR0CK

How Republicans as a whole ought to utilize the Massachusetts model is by pointing out they both increased coverage (the total figure is 98%) and lowered costs WITHOUT a public option. If the Democrats and Obama are sincere about covering the medically uninsured, then there's no reason to insist upon an aspect they desire when it has been proven entirely unnecessary.

If instead Republicans attempt to adhere to a doctrinalist rejection of any government role in the health insurance industry, then in the long term they will ultimately lose. Tort reform, competition opened up nationally are two elements we also should be promoting.

In terms of Commonwealth Care, there are certainly undesirable elements and imperfections about it, but at just 2% the state budget it by no means is 'bankrupting' Massachusetts. If Governor Patrick and his 85% Democrat legislature cannot figure out how to triage state spending, then obviously the elective composition needs to be improved.

kwo (Replying to: BR0CK)

That's disingenuous. Every version of health care reform currently being debated includes significant subsidies so that poor people can buy insurance. The Massachusetts plan has the same sort of provision. What Ambinder didn't note is that there's a large number of Massachusetts citizens who, even with the subsidy, can't afford insurance.

The public option does nothing to alleviate this problem.

RobM1981 (Replying to: kwo)

And Massachusetts is more affluent, per person, than the nation as a whole. They have more money to transfer, and fewer people who need to receive it.

Even so, as shown above, they can't make the payments. The program is in the red and getting redder.

If we want to get real, let's talk universal catastrophic coverage. I don't know anyone against that. But, to make it work, you have to replace Medicaid with the new plan - and there's not a politician alive willing to even propose that.

A fundable program looks like this:

Universal Catastrophic and Pre Natal Coverage. It covers you if you have an accident, a heart attack, cancer (or similar) a non-elective surgery (including deviated septums in most cases, artificial hips except in dire cases, etc.). Rehab is basic. Renal care is basic, but effective. No experimental treatments. No home monitoring, etc. Perhaps a cap on per-prescription costs, forcing the program to utilize somewhat older drugs.

This applies to everyone. It's a "public option," and it's your only choice. It's enough that you don't worry, if you lose your job, "what do I do if I have a car accident? What do I do if I get cancer?"

But - it replaces Medicaid for all able-bodied adults. Only disabled and children retain "full coverage." That's how this is paid for, along with tort reform.

If you want preventive care, mammograms, screening, a private room, experimental drugs, etc., you need to find private insurance for all of this.

Show me the politician brave enough to recommend something like this.

gamesink

RobM1981, the answer to your question is that RomneyCare and ObamaCare are not as similar as Ambinder suggests. Under RomneyCare, Massachusetts expanded one health care subsidy program (MassHealth) and created another (Commonwealth Care). These are paid for by the MA general fund (aka MA's tax dollars). This is different than a public option, in which a new government-run health insurance program would be paid for not by the government (aka OUR tax dollars), but by only those who opt in. What Romney delivered is actually quite a bit more "socialist" than what Obama is proposing.

Jeff

They can't afford it but they are getting much more bang for their bucks.
- that makes perfect sense.

gman

I need to make sure I understand this. Romney care is your example of success. It's working because people that had no insurance are now insured. Taxpayers are OK with subsidizing the uninsured and "lower middle class".

What if 72% wasn't the number? What if it was 25? (I couldn't find the survey in your link) Is it still a success simply because people are insured? What if people thought the increased tax burden wasn't fair?

I'm sure Obamacare will ensure the uninsured. What seems to elude proponents is that taxpayers just don't want to subsidize insurance for others.

I like the final gloss over. "Oh, BTW, they have a cost problem. Once taxes are increased to cover the cost issue, the survey results may change.

BTW, perhaps MA isn't a great example with higher union representation, i.e. higher percentage of people already insured than in other states.

BTW, Discuss: Romneycare vs. Tennicare, Success vs. Failure?

Ben

Ambinder's post is typical of the pro-"public option" folks: Long on assertion, short on hard facts. Marc gives us a few coverage percentages, some polling data (from a lefty, pro-Obamacare outfit, natch), and then assures us that all is well. Massachusetts' state-run health insurance system is fiscally unsustainable, but that is never something the Ambinders of the world will ever admit.