The same reasons for passing near-universal health care in Massachusetts were behind President Obama’s national health care reform. Yet national reform is now under challenge by former Massachusetts Gov. Mitt Romney, who helped to pass the Massachusetts law only to blur his position now that he’s catering to a different set of voters. And now we await the federal law’s challenge before the U.S. Supreme Court, which is deliberating whether the Affordable Care Act is constitutional.
The philosophy behind the Massachusetts law originated with conservative thinkers who believed in an individual health insurance mandate — the free care pool was footing the bill for too many people who sought free health care in emergency rooms without having insurance. Liberals signed on to the plan, convinced that health care is a basic human right.
In April 2006 Romney signed a law mandating that nearly all Massachusetts residents buy or obtain health insurance coverage or face a penalty, also creating incentives for low-cost plans and subsidies for low-income residents. Within four years, the law had achieved its primary goal of extending coverage: in 2010, 98.1 percent of state residents had coverage, compared to a national average of 83.3 percent.
“First, we established incentives for those who were uninsured to buyinsurance,” Romney looked back in a USA Today op-ed in July 2009 urging President Obama to similarly adopt an individual mandate for health insurance. “Using tax penalties, as we did, or tax credits, as othershave proposed, encourages ‘free riders’ to take responsibility forthemselves rather than pass their medical costs on to others.”
While the Massachusetts law was touted as a model for the nation, somewhere along the way, it came to be seen by some conservatives as an intrusive government mandate, an attack on our basic freedoms. Romney has since developed an elaborate dance around the question, saying what’s good for Massachusetts isn’t necessarily what’s good for the rest of the country. He promises to repeal the federal law if elected.
What has become known as Romneycare in Massachusetts is pretty much the same as the national Obamacare that is now under conservative attack. To quote Politifact: “Both leave in place the major insurance systems: employer-provided insurance, Medicare for seniors and Medicaid for the poor. They seek to reduce the number of uninsured by expanding Medicaid and by offering tax breaks to help moderate income people buy insurance. People are required to buy insurance or pay a penalty, a mechanism called the ‘individual mandate.’ And companies that don’t offer insurance have to pay fines, with exceptions for small business and a few other cases.”
While Romney tries to find hairsplitting differences between Romneycare and Obamacare, his fellow conservatives — led by 26 Republican governors — have made a largely political appeal to a Supreme Court with the demonstrated ability to weigh in on partisan matters. Years of complaints about judicial activism have given way to a high court willing to impose its conservative political ideology on the law, risking its own legitimacy in the process.
The decision, due in June, could pose a threat not just to the right of the people through their elected representatives, not the courts, to determine public policy, but to the millions of Americans who don’t have health insurance.
The Constitution asks our government to promote the public welfare. Government generally steps in when markets fail to provide what the public needs or when they go to excess. Twenty-nine million Americans were without health insurance and the need to do something was clear. We’re better off if the Supreme Court upholds the law.