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Health-Care Overhaul 2010

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Brown's victory in Mass. senate race hardly a repudiation of health reform

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The Republican taking over the late Ted Kennedy's Senate seat plans to go to Washington tomorrow. Scott Brown gives Senate Republicans the 41st vote they need for a filibuster and to possibly block President Barack Obama's health care overhaul.

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By Alec MacGillis
Washington Post Staff Writer
Thursday, January 21, 2010

While many are describing the election to fill the late Edward M. Kennedy's Senate seat as a referendum on national health-care reform, the Republican candidate rode to victory on a message more nuanced than flat-out resistance to universal health coverage: Massachusetts residents, he said, already had insurance and should not have to pay for it elsewhere.

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Scott Brown, the Republican state senator who won a stunning upset in Tuesday's election, voted for the state's health-care legislation, which was signed by then-Gov. Mitt Romney (R) and has covered all but 3 percent of Massachusetts residents. That legislation became the basic model for national health-care legislation. Brown has not disavowed his support for the state's law, which retains majority backing in Massachusetts.

Instead, he argued on the campaign trail that Massachusetts had taken care of its own uninsured, and it would not be in the state's interest to contribute to an effort to cover the uninsured nationwide.

"We have insurance here in Massachusetts," he said in a campaign debate. "I'm not going to be subsidizing for the next three, five years, pick a number, subsidizing what other states have failed to do."

In a news conference Wednesday, he said, "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 all throughout the state is, 'What about us?' "

Brown's message underscores a little-noticed political dynamic in a country where rates of the uninsured vary widely, from Massachusetts to Texas, where 25 percent are uninsured. Seeking national universal coverage means sending money from states that have tried hard to expand coverage, mostly in the Northeast and Midwest, to states that have not, mostly in the South and West.

Supporters of the national legislation say this transfer is an unfortunate but unavoidable aspect of expanding coverage. But, they argue, the nation is misinterpreting expressions of self-interest in Massachusetts as grand opposition to universal health insurance.

"Massachusetts's reforms continue to be popular in Massachusetts -- sufficiently popular that Brown did not repudiate them," said Paul Starr, a Princeton public affairs professor. "Here is a state that has enacted a similar reform and it is popular. That should encourage people that if it's done at the national level, that it would work as policy, and that it would be popular."

Conservative analysts disagree, saying the Massachusetts law has been less successful than advertised and that this helped motivate residents to cast a vote they knew would set back national reform. In a new report from the libertarian Cato Institute, Michael Cannon argues that the law has covered fewer people than state data suggest and that it has cost residents and businesses more than supporters say. "Things are not as hunky-dory as people have been saying," he said.

Divining voters' motivation is difficult. In a Boston Globe poll taken in October, 59 percent of state voters said they supported the state law, a drop of 10 percentage points from the prior year, and only 11 percent said they wanted the law repealed. There were no exit polls Tuesday to gauge voters' views on health-care reform.

Federal programs often divert money from richer states to poorer ones, but the regional dynamic is more stark in health-care reform. As it stands, the federal government shares the cost of Medicaid coverage based on states' income, ranging from a 50-50 split in the richest states to 80 percent in the poorest.

But under the legislation, that disparity could grow in a way that does not necessarily accord with state wealth. Many states, and not necessarily the poorest, set stringent terms for Medicaid eligibility, while others have eased entry. In Texas, parents qualify for Medicaid only if their family income is below $5,720, while in Virginia, the limit is $6,380. In Wisconsin, New Jersey, Maine, Minnesota, Illinois, Connecticut and the District of Columbia, the cutoff is $40,000 or higher. In Maryland, it is $25,500.


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