It’s been a few months since President Barack Obama decided to tie up Boston traffic by giving a health care speech right before Game 6 of the World Series. But the Massachusetts health care law, signed by Obama’s 2012 Republican challenger Mitt Romney, is still held up as proof of Obamacare’s inevitable triumph.
Just last week The New Republic trotted out Jonathan Gruber, the MIT professor who was a consultant for both Romneycare and Obamacare, to defend the federal law. Groups like Generation Progress emphasize Romneycare’s success with milennials. And it’s frequently pointed out that Romneycare enrollment started slow, not least by the president himself.
“[A]ll the parade of horribles, the worst predictions about health care reform in Massachusetts never came true,” Obama said in Boston in October. “They’re the same arguments that you’re hearing now.”
Before concluding those arguments are necessarily wrong, it’s worth considering a few things.
1.) Massachusetts had a relatively small uninsured population before Romneycare. According to the National Health Insurance Survey in 2006, the percentage of Massachusetts residents who lacked health insurance was a little more than half the national percentage and already the lowest rate in the country before Romneycare.
In the two years before Romneycare’s individual mandate to purchase health insurance took effect, less than 10 percent of the commonwealth was uninsured, according to the Kaiser Family Foundation. That number dipped below 5 percent in the two years after Romneycare implementation.
As conservative columnist Terence Jeffrey observed in 2011, Romney “took a state where nine out of 10 people had health care coverage and turned it into a state where 9.5 out of 10 people had health care coverage.” Whatever other virtues or flaws Romneycare has compared to Obamacare, the Bay State was already much closer to universal coverage than the rest of the country.
2.) Massachusetts had already wrecked its individual health insurance market before Romneycare. One of the big concerns about Obamacare after the flood of cancellation notices for non-compliant insurance policies is its impact on the existing individual health insurance market. In Massachusetts, that ship had already sailed.
Massachusetts Gov. Michael Dukakis tried to achieve universal coverage through a 1988 plan that forced employers to cover their workers. It was repealed. His Republican successor Bill Weld signed a law that created guaranteed issue, a requirement that individual insurers cover everyone regardless of preexisting conditions, and community rating, which forced them to charge young and old people essentially the same rates.
People waited until they needed health care to buy insurance. Premiums went up on those who stayed insured. Emergency rooms became crowded. The company eHealthinsurance fled the state. Romneycare tried, with varying degrees of success, to fix some of these problems.
But unlike Obamacare, Romneycare was imposed on an individual insurance market that was almost entirely dysfunctional. Free-market health policy expert Avik Roy later estimated, “If 10 is a libertarian utopia, and 1 is a left-wing dystopia, Governor Romney moved Massachusetts’ individual health-insurance market from a 2 to a 4.”
3.) Obamacare isn’t working well in Massachusetts. Massachusetts already had experience with exchanges and the basic architecture of Obamacare, so you would think it would be an early Affordable Care Act success story. You would think wrong. Massachusetts has enrolled just 8,00o people in its Obamacare exchange through the end of January, out of an original target of 155,000.
The Obama administration had to grant Massachusetts a three-month extension to get its exchange website working properly — only half the extension the commonwealth requested — and wade through a backlog of 50,000 paper applications. The head of the Massachusetts Health Connector broke down in tears while describing the exchange’s handiwork.
“These people came here to lead and innovate, and instead they’re doing manual workarounds, and they are embarrassed to tell friends and family that they work for the Health Connector,” Jean Yang wept.