What Massachusetts' Romneycare Can Teach Us About Obamacare (Hint: It Saves Lives, Big Time)
It's been a big few months for Obamacare. Following a much-mocked, botched rollout effort throughout late 2013, which saw just six people able to enroll for insurance through Healthcare.gov the day of its launch, things are looking considerably rosier for President Obama's signature achievement. Particularly since Obamacare finally managed, in late and dramatic fashion, to surpass its target figure of six million enrollees, which many conservatives insisted would never happen. And many ways, Obamacare looks a great deal like its biggest political predecessor — the Massachusetts health care reform law signed by then-Governor Mitt Romney in 2006. Or: Romneycare.
While Obamacare could remain a political liability in the 2014 midterms, the actual health of the law is starting to look pretty robust. And looking ahead, we can make decent guesses about its livelihood using the almost decade-old Massachusetts model. Here are three things Romneycare can teach us about Obamacare...
1. Expanding Health Insurance Access Seems To Help People Live Longer
A new study released in the Annals of Internal Medicine has found a correlation between the implementation of Romneycare, and a reduction in the rate of deaths in Massachusetts — which is a satisfying headline for longtime proponents of Romneycare and Obamacare alike.
It suggests, in short, that expanding insurance access can help save lives. And that's exactly what Obamacare does, by offering a dynamite deal for state-level Medicaid expansion. Originally, the law allowed the federal government to withhold Medicaid funds if states refused to expand, functionally forcing them to accept. But within the same Supreme Court ruling that dramatically saw the law's constitutionality upheld, that ability was struck down, meaning that states more or less have a yes-or-no option on their hands.
It should be a no-brainer, frankly. Until 2017, the federal government covers the entire cost of the expansion, and will still cover a whopping 90 percent of all expansion costs from 2020 onward. It's a fantastic deal, which is sadly being turned down in Republican-led states that sorely need it — Mississippi, for example, which despite having the lowest life expectancy in the U.S. had Medicaid expansion blocked by their state legislature.
2. Even Republicans Can Expand Contraception Access — But Democrats Do It Better
One of the much-discussed aspects of Obamacare, which especially gets conservative tongues wagging in disapproval — its mandate for offering contraceptive coverage through employer-based insurance plans. Just as so many of the nuts and bolts of national health care reform are shared with its state-level predecessor in Romneycare, improving women's access to contraception is no exception.
Then-Governor Romney didn't have to embrace the contraception issue head-on with his version, to be clear — Massachusetts' contraceptive mandate actually predates Romneycare, thanks to a 2002 law requiring its coverage as though it were any other prescription drug. But regardless, expanding access to health insurance broadens the number of people who can reap the reward of that mandate.
At the federal level, Obamacare's contraception mandate is under varying forms of attack, principally via a recent religious freedom suit brought before the Supreme Court by the Hobby Lobby company. But even that case represents a tragic yet narrow slice of Christian-run companies standing in objection — for the vast majority of employers, birth control is now covered and paid for.
3. Enrollment Figures Tend To Be Sluggish At The Start, But Pick Up Steam As Fees Approach
It was cited by the White House all the way back in October of 2013, amid the much-mocked, botched rollout of Healthcare.gov and a deeply unimpressive first month of enrollment — don't freak out if things take a while to get off the ground, because they might. (And they did.)
The White House tried to tamp down immediate expectations, and maintain a sense of calm about the overall trajectory of the law, by pointing to the woeful early enrollment figures for Romneycare — in its first month, a paltry 123 people signed up. But in the final month prior to the uninsured having to pay a fee for breaching the Romney-backed individual mandate, 20 percent of the year's total enrollees, some 36,000 people, signed up.
The lesson? Don't expect people to really feel the heat from a deadline until it's creeping up on them. And don't assume that an abysmal first month or so necessarily spells doom for a landmark policy — enrollment figures at the start of May now show over eight million Americans are signed up.