Massachusetts Special Election: A Mandate on Health Care Reform?

Massachusetts voters have an appreciation for the gravitas of the health care issue. In 2006, the state passed a revolutionary, comprehensive health care reform bill, with the goals of A) expanding coverage to the poor and uninsured, and B) reducing health care costs (last summer I wrote an analysis of the law, the Massachusetts Health Care Access and Affordability Act, if you are interested in a more in-depth look). The bill expanded Medicaid coverage, provided subsidies to the poor to purchase private insurance, and created an insurance exchange called the "Connector," which graded insurance plans and established minimum-coverage mandates.

As a result, approximately 97 percent of the state's population is now insured, by far the highest rate in the United States and similar to the coverage in Western European nations.

Sounds like the bill was a success, right? Not according to Massachusetts voters. Only 26 percent said in a June 2009 Rasmussen poll that the state's health care reform effort has been effective. This is because the costs of insurance premiums are still skyrocketing, with a predicted 10 percent increase in 2010. The entire health care reform effort itself has been costly, with Democratic Gov. Deval Patrick removing several portions of it to eliminate the state's back-breaking budget deficit (he cut illegal-immigrant coverage in August). The cost of the plan in 2010 is more than 20 percent higher than was originally estimated, and that shortfall appears to be growing.

The Boston Globe has come out against the state's health care reform effort: "Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful health care system."

Sound familiar? The Democrats in Washington could be setting the nation up for the exact same experience -- yes, expanded coverage, but at the price of higher-than-expected costs, more taxes, still-rising premiums, and no one seemingly happy about any of it.

So again, it's fitting that Massachusetts voters have been given the chance to make or break national health care reform this year, and the voters seem to be taking this opportunity somewhat seriously. A recent series of polls have shown Brown, the Republican, edging up on Attorney General Martha Coakley, a Democrat. These results are stunning for the "People's Republic of Massachusetts," the overwhelmingly blue Bay State that last sent Kennedy to the Senate with 69 percent of the vote. Polls show 53 percent of the state's voters support the current health care reform plan in Congress, and 45 percent oppose it, although the intensity is much stronger within the ranks of the opposition, and independents in Massachusetts have swung widely to Brown.

It should be noted, however, that polling in special elections is historically unreliable, as it is hard to gauge voter interest and to predict turnout. A Brown win would still be an astonishing upset in a state where Democrats outnumber Republicans three to one, and the money is still on Coakley. The stars would have to be perfectly aligned for Brown to pull off a win -- enough conservative excitement, enough independent anger, and enough Democratic complacency.

If Brown ends up winning this thing, it will be another indication that health care reform is dead on arrival -- that the voters don't want it, and that it won't play well for Democrats anywhere in the 2010 campaign. It will be repeatedly noted that the state with the most experience in health care reform voted to shut it down. It could be a game-changer.

However, even if Brown loses by a slim margin, it would be a warning shot of voter anger across the bow of the Democratic ship. If health care reform isn't going to be a winning card in Massachusetts, it certainly won't be anywhere else.