The Washington Post offered up one of the most intriguing analyses of Republican Scott Brown’s Senate victory in Massachusetts Tuesday. Rather than a repudiation of health reform, the article by Post staff writer Alec MacGillis suggested that voters instead rejected the idea of subsidizing health insurance expansion outside the state.
A quote from Brown at a post-election press conference Wednesday was at the heart at that thesis. "We have insurance here in Massachusetts. There are some very good things in the national plan that’s being proposed, but if you look at -- and really almost in a parochial manner -- we need to look out for Massachusetts first... The thing I’m hearing throughout the state is, ‘What about us?’ " said Brown.
Massachusetts, of course, passed historic health care legislation in 2006 that requires almost everyone to buy health insurance. The state government provides subsidies to help low-income people buy it. Massachusetts also has generous Medicaid eligibility guidelines.
Under federal reform, taxes on high-income wage-earners or premium health plans would help cover the costs of expanded coverage. Brown, who supported the Masschusetts legislation, is basically saying that voters didn’t want to pay twice for health reform — paying taxes for the state plan, as well as new ones for the federal plan, which would benefit most the states with high rates of uninsured people. These tend to be southern states; 25 percent of people in Texas, for example, do not have health insurance.
This is a new twist on geographic disparities, which so far in the health care debate have focused on the differences in Medicare spending per enrollee — which also tends to be higher in southern states. There’s been little attention to the issue highlighted by Brown: that states that have worked to expand coverage effectively get punished financially for trying to solve the problem on their own.
Minnesota is one of these progressive states, with generous Medicaid eligibility and programs such as MinnesotaCare, which has meant the state has long had one of the lowest uninsured rates in the nation.
Not surprisingly, a recent Health Affairs policy journal article listed Minnesota as a "loser" under one federal health reform scenario. That’s due both to its progressive programs as well as its relatively affluent population.
Health Affairs also notes the irony at play in health reform. States that gain the least under federal reform tend to be represented by Democrats, who have pushed for reform. States that will benefit most under federal health reform tend to be represented by Republicans, who have done everything humanly possible to block it.