Chapter 2


The Model for Federal Healthcare Reform and a Case Study on What to Expect

There is little doubt that the federal reform legislation was modeled closely on the 2006 Massachusetts reform legislation. Lest there be any doubt, the Massachusetts Health Connector (the nation's first state-sponsored insurance exchange) proudly proclaimed shortly after the federal legislation passed:

Leading the Way: The first battle of the American Revolution. The first school, telephone call and basketball game. What do they have in common? Massachusetts. Now we're the model for national health insurance reform.

As will be seen throughout this chapter and the balance of the book, the extent of the federal legislation's reliance on the Massachusetts legislation is striking. As such, to gain an understanding of the federal legislation, it is necessary to first understand its source. More importantly, the experience of Massachusetts with its reform, notably as reflected in the new 2010 legislation described at the end of the chapter, portends what is likely to happen with the federal legislation.

Massachusetts was the first state to mandate universal health insurance coverage and to establish an enforcement mechanism tied to income tax administration (through the Massachusetts Department of Revenue) and annual individual tax returns wherein a penalty is imposed for each month a resident does not have coverage. In addition to this and other elements detailed following, the federal ...

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