On Sunday, White House political adviser David Axelrod appeared on ABC's "This Week" and tried to brush aside the message sent by Sen. Scott Brown's (R-Mass.) improbable election. "Senator Brown comes from a state that has a health care plan that's similar to the one we're trying to enact here," Axelrod said. "We're just trying to give the rest of America the same opportunities that the people of Massachusetts have."
Appearing after Axelrod, Sen. Lindsey Graham (R-S.C.) could barely contain himself. "The American people are getting tired of this crap," Graham spluttered. "No way in the world is what they did in Massachusetts like what we're about to do in Washington." Actually, says Massachusetts Treasurer Tim Cahill, the two health care bills are very much alike -- and that's exactly the problem.
Both health care plans rely on the individual mandate, subsidies, and exchanges intended to match buyers with health insurance plans. "If President Obama and the Democrats repeat the mistake of the health insurance reform adopted here in Massachusetts on a national level, they will threaten to wipe out the American economy within four years," Cahill said, launching an all-out offensive against Romneycare in Massachusetts and its cousin Obamacare nationwide.
Medicaid costs have continued to explode, rising from $7.5 billion to an estimated $9.2 billion since the Massachusetts health care law has taken effect. More people now have coverage, but of the 407,000 newly insured only 32 percent paid for their insurance entirely on their own. The remaining 68 percent were either partially or wholly subsidized by the taxpayers. Only 5 percent of newly insured Massachusetts residents who are not receiving any taxpayer benefits obtained their coverage through the state's "Connector" health care exchange.
What's more, according to figures obtained from Cahill's office, only 23 percent of those enrolled in the state-managed health insurance programs pay anything toward their coverage. About 99,000 newly insured Massachusetts residents now receive free coverage through Medicaid. Another 87,000 receive 100 percent taxpayer subsidies through the Connector's "Commonwealth Care" program. And another 26,000 are legal immigrants ineligible for federal subsidies who benefit under the Commonwealth Care Bridge program.
Not only has health care reform cost the state an additional $4.2 billion, but small businesses and consumers are getting walloped. Health care costs continue to skyrocket. Insurance premiums have jumped 12 percent over a two-year period. So much for bending the cost curve.
In a conference call yesterday, Cahill blamed both conceptual flaws in the bill and Gov. Deval Patrick's implementation. "We haven't changed the way we deliver health care. We haven't changed the way we pay for health care," he said. "Nothing's changed about the cost structure but we've blown a huge hole in the budget to increase coverage by 400,000." Just more people are being moved into a broken system, largely at taxpayer expense.
Cahill argued that the consequences of repeating this at the national level will be even worse. First, Massachusetts already had a high percentage of its population covered. The 2006 Bay State health care reform only insured another 4 percent. In many states, the percentage of uninsured is far higher. Second, as even critics of Cahill's analysis of Romneycare acknowledge, Massachusetts has benefited from both subsidies and regulatory concessions from the federal government.
"Who, exactly, is going to bail out the federal government if this plan goes national?" asked Cahill. He implored "the federal government, Democrats, and Obama" not to "make the same mistake we made in 2006." "There is a reason people in Washington want this pass to quickly," Cahill continued. "We're going to be paying a lot more money."
Reporters asked Cahill for some of the benefits. Did near-universal coverage in Massachusetts bring about a drop in the reliance on emergency room care? No, the state treasurer replied. What about cost benefits from preventive care? Not that Cahill was aware of.
Could it have been better implemented by, say, Mitt Romney rather than Deval Patrick? "I could probably agree with that partially," Cahill allowed. "I certainly have some concerns about how Governor Patrick has implemented it." But Cahill called the bill "fatally flawed from the beginning."
The treasurer noted that the theory was by increasing access, it would bring down health care costs. Instead Massachusetts has seen costs increase almost across the board. Those costs, he said, "are being passed on to businesses and consumers in the form of premium increases."
Cahill's timing has as much to do with Massachusetts politics as the looming national health care debacle. Elected state treasurer as a Democrat, Cahill bolted the party last July and is running for governor as an independent -- a designation shared by 51 percent of the commonwealth's registered voters. This stance allows him to outflank the Republican candidates, tap into the sentiment that propelled Scott Brown to the Senate, criticize the Democratic incumbent, and distance himself from his former party.
But by forthrightly attacking an approach to health care reform that has been embraced by Republican darlings, Cahill may be doing conservatives -- and the country -- a service. "The insurance companies were at the table, the hospitals were at the table, the large providers were at the table," he said during yesterday's call. "The taxpayers and small businesses weren't at the table. It appears to be repeating itself at the national level."
Massachusetts nearly derailed the federal health care juggernaut once before. It remains to be seen whether Cahill can get that to repeat itself at the national level too.