Massachusetts Health Care Reform Is a Pioneer Effort, but Complications Remain

On 12 April 2006, Massachusetts introduced health care reform legislation “to provide access to affordable, quality, accountable health care” that became law in a bipartisan vote of 154 to 2 in the House of Representatives and 37 to 0 in the Senate. When then-governor Mitt Romney (R) signed the groundbreaking legislation, Chapter 58 of the Acts of 2006, he declared that “an achievement like this comes around once in a generation, and it proves that government can work when people of both parties reach across the aisle for the common good.” Over the course of the next year, policymakers, stakeholders, and the newly formed Commonwealth Health Insurance Connector Authority addressed difficult issues pertinent to the law while new governor, Deval Patrick (D), who took office in January 2007, provided continued gubernatorial backing.

The state's new health care reform law aimed to extend affordable, high-quality coverage in a sustainable way to all residents and reduce the state's estimated 400 000 to 600 000 uninsured persons to nearly 0 over the course of the first 3 years (see Appendix for additional U.S. Census data). Policymakers planned to achieve near-universal health care by moving uninsured people from uncompensated care to insured care by expanding on employer-sponsored health insurance as the primary source of coverage for state residents; creating new, lower-cost plans for individuals and small businesses, with improved portability and flexibility for part-time and seasonal workers; and funding public programs for people without access to employer-sponsored health insurance. It also created standards of adequacy and affordability for new, state-endorsed insurance plans while encouraging pretax treatment of health insurance premiums for employees.

The law carried a first-ever individual mandate requiring residents to buy health insurance if they do not already have it and imposed financial penalties for nonparticipation. Meanwhile, it also maintained a modified health care …