RomneyCare: It's Working (Mostly), And It's Popular (Largely)

The nation's most ambitious experiment in universal health insurance is succeeding on its own terms, and has become fairly popular, a new survey minds. 96% of working age adults have health insurance in the state today, which is significantly higher than the national average. Also up: the percentage of people with private health insurance. It's now as high as 70% among seniors. An Urban Institute study finds that 72% of state residents are happy with the effort. The Massachusetts plan included an individual mandate, required employers to either provide coverage or pay into an insurance pool, expanded Medicaid and created a new government health care program for the lower middle class, and created a health connector agency that matches individuals with the private plan of their choice. About half of those who enrolled in the new programs are now covered by government-run plans.

In calling it RomneyCare, I'm continuing the tradition of identifying the health care program by the chief executive who signed it into law. As Romney's health policy advisers will tell reporters, Romney didn't favor the mandate that Massachusetts Democrats added to it -- Romney wanted people who refused to buy insurance to post a bond that would cover their emergency care. But he supported the package in the end. It is something that our all-or-nothing political system doesn't tolerate: a government plan administered by private companies; a mixture of regulation and market incentives. A hybrid. (Remember -- Sen. Edward Kennedy was a major Romney ally.) Compared to other states, Massachusetts had a relatively easy go of it -- its social safety net was generous and the percentage of unemployed persons was lower than the national average to begin with. Critics worried about the program's costs -- it included income subsidies --- and who would bear the brunt of the transferred costs. (Critics say that it has amounted to a tax on the middle class -- technically true, but the middle class seems OK with it.)

The recession has hurt the program's fiscal sustainability; more uninsured residents means that more money is needed to finance the system, and the legislature has struggled to find ways to preserve the same level of service for an expanded pool of people needing insurance. So -- costs remain an issue. But advocates of the plan say that, relative to the past, the state is getting much more bang for its bucks.

Cost containment in the future may rest on the fate of the second phase of reform efforts -- large changes to the delivery part of the system.