Massachusetts: a Cautionary Tale

Before and after Gov. Mitt Romney (R) signed into law the Massachusetts health care reforms of 2006, Cato scholars predicted that this attempt at central planning would fail. Both Michael Tanner and David Hyman predicted that the cost of the reforms would exceed projections. The Boston Globe recently reported:

The subsidized insurance program at the heart of the state’s healthcare initiative is expected to roughly double in size and expense over the next three years — an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions. 


State projections obtained by the Globe show the program reaching 342,000 people and $1.35 billion in annual expenses by June 2011. Those figures would far outstrip the original plans for the Commonwealth Care program …


The state has asked the federal government to shoulder roughly half of the program’s cost from 2009 through 2011, but there is no guarantee of that funding. 


“The state alone cannot support that kind of spending increase,” said Michael Widmer, president of the Massachusetts Taxpayers Foundation, a business‐​funded budget watchdog group. 

I predicted that shifting uncompensated care subsidies to insurance subsidies wouldn’t much reduce uncompensated care. The Globe reports:

[Romney] has repeatedly suggested that the state could insure low‐​income residents largely by reallocating money paid to hospitals and health centers that serve the uninsured … As more uninsured residents were covered, the state had expected to shift hundreds of millions of dollars from free care to insurance subsidies, but the drop has been slower than predicted.

David Hyman noted that “the Massachusetts plan does nothing to control the cost of health care—and health care in Massachusetts is already pricey because of the heavy reliance on teaching hospitals and academic medical centers.” I wrote, “An individual mandate would not fix our broken health care system. It would simply pump more money into that system. ” The Globe reports:

Even with federal backing, the state may not be able to afford the insurance initiative as designed, because the law did not make any attempt to trim wasteful health spending, said Alan Sager, a Boston University professor who specializes in healthcare costs.

The Globe also notes, “There has been no discussion of a tax increase to pay for the healthcare plan.” So far.


Other states (and the District of Columbia) should take note.