Universal health care: What will make it work?

A tip of the hat to Tom Mayo at HealthLawBlog, who posted yesterday’s news on the Arnold’s unsurprising veto of the California universal health care bill (link to story on the bill from my earlier post here), and the release of a Congressional study on health care access and affordability, laying out a five-year plan for improvement.  Under the law that called for this report, the president has 45 days to respond with recommendations for legislative and administrative changes.

Tom asks what differentiates Massachusetts — where a universal health care plan is getting up and running, with some fits and starts — from California, where the idea turns out to be a nonstarter.

There is an interesting series of articles published this month by Health Affairs as a web exclusive that includes a wide range of analysis and prognostication.  One of the articles, co-authored by John McDonough of Health Care For All and A Healthy Blog notes that Massachusetts was pushed or pulled into this "third wave" of health care reform by the threatened loss of almost $400 million a year in federal dollars made available under a Medicaid waiver.  The money had previously been directed straight to the state’s two biggest disproportionate share hospitals, and the feds wanted to see the money directed to Medicaid beneficiaries rather than institutions.  The Massachusetts plan redirected the money to the satisfaction of the feds, who approved the plan and renewed the waiver.  There are other pieces to the plan, of course, but this was one key element that galvanized the support needed.   

There are many challenges on the road to full implementation of the Massachusetts plan but, thus far, while some compromises have been made, the general thrust of the plan remains intact.  We’ll see if any bills proposing significant overhauls or repeal are filed for the coming legislative session.