Massachusetts health-care reform leader could play larger role nationally

By Alec MacGillis
Thursday, April 15, 2010; 5:06 PM

Don't be surprised if you start hearing the name Jon Kingsdale a lot in the near future.

Kingsdale is the founding executive director of the Massachusetts Health Connector, the agency at the heart of the state's 2006 universal health-care law that served as the model for the national health-care legislation that President Obama signed last month. Kingsdale has been widely credited with leading the implementation of the state law -- getting people to comply with Massachusetts's mandate to obtain health insurance, and setting up the Connector, a marketplace where people without employer coverage buy insurance, just as will occur on the state-based "exchanges" envisioned by the national law.

And on Thursday, Kingsdale announced that he is resigning -- with a hint that he has in his sights a role in implementing the national legislation.

"For me personally, the opportunity to help lead the implementation of health reform in Massachusetts since its inception in June 2006 has been uniquely gratifying," he wrote in his resignation letter to the Connector's board. "It has also reinforced my long-standing interest in developing new ventures, my innate bias toward action, and a passion for healthcare reform. In my next venture, I hope to play some role in national healthcare reform and to continue working with each of you."

Kingsdale also included a thinly veiled retort to Republican Mitt Romney, who signed the Massachusetts law as the state's governor but has in recent weeks been playing down the similarities between it and the national legislation, which he has loudly criticized. "We should all feel very proud of having created the model for national health reform," Kingsdale wrote. "The power of the Bay State's example is enormously consequential. I believe that national reform would not have happened without it."

The Massachusetts law shares the same basic approach as the federal law: Insurers are required to offer coverage to all customers who seek to buy it, almost everyone is required to obtain coverage and government subsidies are available to those who cannot afford coverage on their own.

The state law has succeeded in expanding coverage -- only about 2.6 percent of state residents lack insurance today, down from about 9 percent in 2006, and the law's burden on the state budget has not been as heavy as some feared. But the law did little to address the challenge of restraining the nationwide rise in health-care costs, and premiums are continuing to rise, particularly for small businesses. This has state officials now contemplating several controversial measures, such as rejecting requested insurance rate increases, limiting the rates that hospitals and doctors can charge insurers, and urging doctors to form salary-based networks where they are paid a lump sum to keep people healthy.

It is not hard to imagine that the federal government, or some private foundation or industry group, would be interested in availing themselves of Kingsdale's expertise in the daunting implementation phase that now lies ahead for the national law. During the national debate, Kingsdale frequently offered his insights, such as stressing the importance of a massive publicity campaign to promote the individual insurance mandate.

In Massachusetts, he noted, the state made it easy to sign up -- people who qualified for subsidized coverage got help filling out forms at safety-net hospitals and clinics, while others could use a Web site to determine whether they qualified for subsidies or call the Connector for assistance. The Boston Red Sox promoted the mandate, pharmacy loudspeakers intoned it, grocery store receipts carried reminders and churches coaxed congregants. The Connector held 200 meetings with employers and two dozen outreach sessions, community groups received funding to help people sign up, and residents got red-lettered postcards in the mail.

The promotion worked in Massachusetts. But Kingsdale warned that the challenge would be even greater at the national level -- the penalties for the mandate are smaller in the national bill than they were in Massachusetts. And the Massachusetts law had bipartisan backing in the political establishment that the national law now lacks.

But that didn't keep Kingsdale from supporting the national legislation. As difficult as a national overhaul would be, it made more sense than leaving health reform to each individual state, because too many states had shown a distinct lack of interest in expanding coverage and reforming health care, he said in an interview with The Washington Post in January.

"There just isn't the political will" in many states, he said. "To leave this to the states is not realistic -- it's what we did for the last 40 or 50 years."

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