Rosemarie Day, a top architect of the commonwealth’s landmark health care reform, delivered the keynote address at the University of Massachusetts Boston’s fall convocation last week.
Health care reform has become one of the fault lines in this year’s presidential campaign, with President Barack Obama and Republican nominee Mitt Romney sharply divided on the future of the Affordable Care Act, passed by Congress in 2010.
Day was the founding deputy director and chief operating officer of Commonwealth Health Insurance Connector – the public exchange created by the Massachusetts health reform bill signed into law by then Gov. Romney in 2006.
“Together, we helped to insure over 400,000 more people in this state,” Day said. “I think that’s really something that we can be proud of.”
Day is now president of her own consulting firm, Day Health Strategies, and a visiting fellow in the McCormack Graduate School of Policy and Global Studies.
The statistics show that health reform has worked, Day said. Only 2 percent of Massachusetts residents lack insurance – the lowest rate in the country – and nearly all children are covered.
“It has truly made Massachusetts a national leader,” Day said, explaining that the Bay State law served as a model for the federal reforms signed by Obama.
The Supreme Court upheld the Affordable Care Act this summer after a constitutional challenge, but Day said the law is not yet safe.
“That was June and this is September, and the presidential election is two months away,” Day said.
The election outcome will be critical because the candidates have vastly different views on health reform, Day said. Obama claims the Affordable Care Act as one of his signature achievements, while Romney has said he would repeal key portions of the law.
Even if Romney does not repeal the law, Day said he could easily erode it by eliminating funding. “I don’t think we’re really going to know for certain what he’ll do until he takes office,” she said.
Americans remain divided on the issue – a split Day has seen firsthand as she works with states trying to implement their own health care reforms. When asked about the law as a whole, most people say they oppose it. But when asked about individual features of the ACA – such as allowing children to stay on a parent’s insurance plan until age 26, or ensuring people with pre-existing conditions are covered – most Americans are in favor.
“The individual aspects are quite popular,” Day said.
Day said health reforms are difficult to discuss because the issue has become so politicized. And the strongest opposition to the ACA, surprisingly, comes from states with the highest rates of uninsured residents.
In Texas for example, a state where many political leaders and residents oppose the law, 25 percent of residents are uninsured. “Studies show that the people who would benefit the most are those who are the least aware. Voters face a choice on something that they, frankly, don’t understand.”
While the law and its details are vast, she said it really comes down to two points: access and affordability.
About half of Americans are insured through their employer, but “if you are working for a small business or part-time for a large business, chances are you’re not covered at all,” she said. This leads many people to forgo insurance altogether, whereas sick people who need health insurance are often priced out by high costs. “In most states, if you have a pre-existing condition, like asthma or diabetes or a heart condition, you either can’t get [health insurance] or it would be priced so high that you’d have to be Bill Gates to be able to afford it.”
Under the state’s law and the Affordable Care Act, however, insurance companies are required to cover everyone. “Healthier people may pay more originally, but they benefit from the guarantee that they can keep it if they get sick someday.”
Day predicted that, if Obama is re-elected, approximately 15 states will follow Massachusetts’ lead in the next few years. Others will either procrastinate or refuse to implement the law. “I believe we can’t reverse the trend of having more and more uninsured people without having a national solution.”
Day, who has researched health care systems in Europe and elsewhere, says different nations require different solutions.
“It turns out, there are as many flavors of health reform in Europe as there are languages spoken there,” she said. She said that the United States will be successful if it harnesses the existing free-market system and combines it with a government safety net. “It’s better than just doing nothing or leaving the market unfettered to do its own thing.”
Regardless of what approach the country takes, Day said that something needs to be done. “Doing nothing is not viable for much longer,” she said.
Day recalled meeting a young woman who was working full-time at her family’s restaurant. “She made enough to live but not to buy health insurance.” When she finally got it as part of the state subsidy, the woman went to the doctor for the first time in years and found out she had breast cancer. Luckily, it was diagnosed early enough that she could be treated.
“Without that health insurance coverage, she wouldn’t have gone to the doctor,” Day said. “It might have been too late at that point.”