Scott MacKay Commentary: Look To RI & MA Republicans For Ideas On Health Care

Jul 21, 2017

Now that the latest Republican effort to replace the Affordable Care Act has failed, RIPR Political Analyst Scott MacKay says it’s time to resurrect some ideas with roots in Rhode Island and Massachusetts.  

So much for the master deal makers in Washington. Even though they control the Congress and White House, President Donald Trump and Republican lawmakers don’t seem to be able to address the gnawing issue of health care.

So far, the party controlling things in Washington, D.C. can’t get to 50 votes in the Senate for a plan to overturn the Affordable Care Act, better known as Obamacare. Trump’s proposals appear little more than sloganeering, tweeting and bluster. Last week the president said GOP senators would look like “dopes” if they couldn’t repeal Obamacare.

This is a good time to go back to the future and consider strategies advanced by Republicans from the Bay State and Ocean State. In the early 1990s, Democrat Bill Clinton was president. He tapped his wife Hillary and Rhode Island health care guru Ira Magaziner to overhaul the nation’s health care system. The result was a complicated, Rube Goldberg concoction founded on an employer mandate. The proposal crashed, opening the door to the 1994 takeover of the House by Newt  Gingrich’s Republicans.

At the time, Republicans had an answer to requiring employers to provide health insurance. It was called the “individual mandate” and was advanced by Rhode Island Sen. John Chafee. Chafee garnered the support of Bob Dole, then the Senate’s GOP leader, and Gingrich. Even the conservative Heritage Foundation backed it.

The individual mandate was pitched as a conservative counter to Democratic single-payer proposals, based on the Canadian model. Massachusetts Sen. Ted Kennedy was an advocate of such a plan.

The requirement that everyone obtain insurance was seen by Republicans as combining the virtue of personal responsibility with a way to curb the cost-shifting that has long dogged American health care. The only way to control costs and provide access to health care to all Americans was to require that everyone have insurance.

While Chafee’s individual mandate never gained traction in Washington, it did gain a champion in Massachusetts –Gov. Mitt Romney. Romney’s health director was Christine Ferguson, who had served as a Chafee aide when the senator developed his plan.

Romney worked with Ted Kennedy and others to develop the Bay State’s near- universal coverage model. It hasn’t hurt the Massachusetts economy; Boston has become one of the world’s top innovation cities.

Romneycare turned out to be the template for Obamacare. When Obamacare was challenged, the U.S. Supreme Court upheld the individual mandate. Since, the Republican health care consensus has shattered, as the party’s inability to craft an alternative to Obamacare shows. A large segment of the GOP has moved to the libertarian right. They seek free-market solutions to health care, which is something no major industrial nation has pulled-off.

One of the big stumbling blocks is Medicaid, the program that covers health insurance for the poor, elderly and disabled. It’s financed jointly by state and federal governments. In most states, Medicaid and education aid are the two biggest budget items.

Medicaid surely can be run more efficiently; is there a government program that couldn’t? But there are many myths about Medicaid. Some think undocumented immigrants and single mothers with large families drive Medicaid costs.

Fact is that in just about every state, one-third of the Medicaid recipients are responsible for two-thirds of the costs, says Anya Rader Wallack, former head of the Massachusetts Medicaid Policy Institute and former Rhode Island Health and Human Services Secretary. Those responsible for the bulk of costs are the elderly, many in nursing homes, and people with severe disabilities.

Rhode Island, with a viable Obamacare program (Ferguson also ran this program) and Massachusetts, with Romneycare,  aren’t perfect; neither state has cured medical cost inflation. Yet both states have near-universal health care coverage. Maybe Washington should consider health care in our corner of New England as senators embark on yet another change in our health delivery system.

Scott MacKay’s commentary can be heard every Monday on Morning Edition at 6:45 and 8:45 and on all Things Considered at 5:44. You can also follow his political analysis and commentary at our “On Politics” blog at