Massachusetts in 2006 passed major health reform legislation (known as “Chapter 58”), designed to provide “universal coverage” to Massachusetts residents of all incomes. However, Chapter 58 has significant weaknesses that prevent it from living up to its hype and is widely recognized as an unsustainable effort over the medium-term.

Background:
Chapter 58 was passed when the federal government insisted Massachusetts reduce the number of uninsured residents using the state’s Free Care Pool, or lose almost $400 million in matching federal grants. The law constituted a compromise between a Democratic state legislature, a Republican Governor, the Bush Administration, and powerful political entities in the state. The legislation thus included progressive provisions to expand public subsidies for health care, conservative calls for “individual responsibility,” and an effective moratorium on reform of the existing health care system to satisfy the health care industry in the state. The bill was introduced and passed within 24 hours with little public scrutiny. Early media coverage lauded Massachusetts for the introduction of the bill, deeming it “the only American state committed to comprehensive medical care” (CBS) and calling the bill an unprecedented piece of legislation that could achieve what “no other state has been able to do” (The New York Times).

What is Chapter 58?
Chapter 58 is a health coverage reform bill, based on a model of state reform that attempts to “plug the gaps” in health insurance coverage through new or expanded public programs, without making significant alterations to the health insurance or health care delivery system. Under Chapter 58 a public subsidy plan called “Commonwealth Care” subsidizes health coverage for residents up to 300% of the poverty level. The bill requires most other residents to purchase health insurance on their own or face penalties (an “individual mandate”). The law attempts to impose a small fine on employers not offering health benefits to their workers, and increased payments to many hospitals and health centers. The law, premised on moving the population into privately managed insurance plans, has also had a dramatic impact on the existing health care safety net in Massachusetts (called the “Free Care Pool”), as well as the hospitals and health centers who treat the uninsured.

Further Resources:

• Similar Reforms in Other States
• Health Care Costs and the Sustainability of Reform
• The Individual Mandate: Origins and Impact
• The Impact on Business and Labor
• The Health Care Safety Net and the Free Care Pool
• Mass-Care and JWJ Pamphlet: ‘Massachusetts Health Reform: Solution or Stopgap?’
• Mass-Care’s Slide Show on the Massachusetts Health Reform