Commentary on Part II: Conducting the Experiment

Abstract

States are often termed “laboratories of democracy,” and this is particularly true for Massachusetts and health reform. Since the 1980s, every decade, Massachusetts has pioneered dramatic health policy experiments that have influenced national policy. The most striking example is the 2006 reform, enacted under then-Governor Mitt Romney. “Romneycare” was driven by many factors, including a growing number of uninsured in the state, federal pressure to reduce subsidies to safety-net hospitals, and political pressure from a coalition of activist and religious groups allied with healthcare providers. The law has been very successful, as health coverage increased substantially in Massachusetts, providing life-changing opportunities for state residents to get health treatments that they need. The success of the Massachusetts reforms led directly to the ACA, modeled on the Massachusetts blueprint. Meanwhile, as the national ACA experiment unfolds, Vermont is embarking on its own dramatic reform. The building blocks are being assembled there for a single-payer reform that could transform healthcare financing and delivery in the USA. In both the Massachusetts and Vermont reforms, policymakers have learned that paying close attention to data is critical to monitoring success and adjusting policy.