Massachusetts is mentioned five sentences into the majority opinion, written by Chief Justice John Roberts, upholding the Affordable Care Act's federal subsidy.
The opinion begins by describing failed attempts by several other states to expand health care access. But then, Roberts writes, Massachusetts required people to buy insurance and provided tax credits to make it more affordable.
"The combination of these three reforms — insurance market regulations, a coverage mandate, and tax credits — enabled Massachusetts to drastically reduce its uninsured rate," Roberts wrote.
But those tax credits that were at issue in this case, King v. Burwell. The Supreme Court ruled Thursday upholding a key element of the Affordable Care Act. Like the Affordable Care Act itself, the Supreme Court’s ruling is rooted in Massachusetts.
Wendy Parmet, director of the program on health policy and law at Northeastern University, says the court ruled that when Congress drafted the ACA, they meant to implement all of those Massachusetts legs — regulations, mandated coverage, and tax credits.
"What the court said here was you have to read the ACA in light of all three legs of that stool," Parmet said. "And that’s really what Congress was attempting to do with the ACA, to do what Massachusetts did, and that understanding has to be read into the ACA.”
Brian Rosman, research director at the Massachusetts advocacy group Healthcare for All since the state healthcare law first passed, says there’s a lot of pride that it was the blueprint for the federal law.
“There was a continuous shuttle of experts from the Boston area to DC letting the federal officials know what worked and what didn’t work, and what we learned,” Rosman said.
One of those experts was Tim Murphy, who was secretary for Health & Human Services under Gov. Mitt Romney.
“I’m satisfied that people looked at the work we did here, understood the logic that underpinned it, understood what we were trying to accomplish from a policy perspective," Murphy said. "And they felt that there were elements of that that could be helpful to other people in other states.”
Murphy’s a bit ambivalent about the legacy of our state’s law in shaping the ACA, though. He says ever since the Massachusetts exchange had to start complying with requirements of the federal system, there’s been a lot of wasted money and effort.
Healthcare for All’s Executive Director, Amy Whitcomb Slemmer, says she’s proud of the state’s history of leading on health care reform, and sees it continuing into the future.
"Just as we have figured out part of the secret for getting access to almost everybody, we now want to really transform our healthcare system so that we’re talking about keeping us healthy," Slemmer said.
She’s hopeful that a state law passed in 2012 will help move the healthcare system towards that goal, while controlling healthcare costs. And she hopes some day that could be replicated nationally, too.
