A LIFETIME OF SERVICE TO MASSACHUSETTS

Health Care

Pursuing Comprehensive Health Coverage

Throughout his career, Senator Kennedy has fought to ensure that all Americans have access to high quality, affordable health care. This was the cause of his life.

It began in 1966 when Senator Kennedy visited the Columbia Point Health Center in Boston - a successful clinic bringing health care to low-income residents of the community. Kennedy came away impressed with the clinic’s ability to provide treatment to low-income populations. He also knew of a successful clinic in Mound Bayou, Mississippi. He saw in Columbia Point and Mound Bayou a model for the nation and introduced an amendment to the Economic Opportunity Act that set aside $51 million to get another 30 centers started around the country. Today, as a direct result of Sen. Kennedy’s vision as a 34-year-old, first-term senator, 20 million low-income Americans receive access to quality primary care at 1,200 community health centers across all 50 states and U.S. territories.

Senator Kennedy’s success replicating the Columbia Point Health Center model across the country was the very beginning of his long journey to make health a care right for all Americans, not a privilege of the few.

Massachusetts Health Care

No one has had more impact on the remarkable progress in Massachusetts toward universal health coverage than Senator Edward Kennedy. Over the past 15 years, Massachusetts has made more progress toward providing quality and affordable health insurance for all its residents than any other state. At each step in this journey, Senator Kennedy provided crucial leadership and support to achieve and sustain this progress.

In 1996, the Commonwealth passed a major health access law to expand and reorganize the state’s Medicaid program into what is now called “MassHealth.” The law also expanded health insurance coverage for children, eventually achieving near universal coverage for all kids in the Massachusetts.

Crucial to the 1996 achievement was obtaining from the Clinton Administration a “Section 1115” Medicaid waiver enabling the state to expand coverage and to finance the expansion through savings from a reorganized and more efficient Medicaid program. Senator Kennedy worked closely with officials from the administrations of Governors William Weld and Paul Cellucci to convince the Clinton Administration to approve the necessary waiver. As a result, Massachusetts expanded its Medicaid program to cover 350,000 formerly uninsured, low-income persons between 1997 and 2000.

Senator Kennedy used the Massachusetts children’s health expansion as his own model in devising, in early 1997, what became the new federal Children’s Health Insurance Program (CHIP) approved in July, 1997 as part of that year’s Balanced Budget Act. The CHIP program developed to provide coverage to seven million lower-income children. Early in 2009, the program was reauthorized and expanded and will soon cover an estimated 11 million children.

In 2002, as the first Section 1115 waiver expired, Senator Kennedy again worked with state officials (under Governor Jane Swift) and federal officials (under President George Bush) to renew the waiver for an additional three years.

A unique aspect of Massachusetts’ 1115 waiver was special “supplemental payments” to Boston Medical Center and the Cambridge Health Alliance to help them survive in the reformed environment. By 2005, these payments amounted to approximately $350 million in additional payments to the Commonwealth. In late 2004, Bush Administration officials communicated their intention to eliminate these payments in any future waivers. At this point, Senator Kennedy and Governor Mitt Romney teamed up to convince Bush Administration officials to permit Massachusetts to continue receiving these payments and to reuse them as subsidies to help lower-income uninsured persons obtain coverage, and not as subsidies to institutions. The new three-year waiver took effect in July 2005.

This agreement between Massachusetts and US officials, brokered by Senator Kennedy, was the major impetus leading to passage of the landmark Massachusetts health reform law signed in April 2006 by Governor Romney with overwhelming support from the Democratic-dominated Massachusetts Senate and House of Representatives.

Implementation of this law has triggered the most dramatic reduction in the number of uninsured of any state in the nation’s history, from nearly ten percent in 2006 to approximately 2.6 percent in 2008. Massachusetts’ health reform law has become the essential blueprint for national health reform plans now being advanced in the United States Senate and the House of Representatives.

In 2008, Massachusetts reached agreement with Bush Administration officials for a fourth Medicaid waiver to continue robust and effective implementation of the State’s health reform law.

While Senator Kennedy worked with four Governors and two Presidents – four Republicans and two Democrats – no one else has been as consistently involved to ensure both the attainment of progress and its continuation.

Massachusetts is the model state in the United States in working successfully to achieve near-universal coverage for all its residents. This progress is one more monument to the remarkable health care legacy for Senator Edward Kennedy.

Medicaid Waiver and Massachusetts Health Reforms

From 1997 – 2008, Senator Kennedy was the central and driving force behind a sustained, bipartisan effort with historic results – the expansion of quality and affordable healthcare to more than 750,000 previously uninsured Massachusetts residents. This historic achievement was the result of four “Section 1115” Medicaid waivers given to the Commonwealth from the Federal government: 1997, 2002, 2005 and 2008. The 1115 waiver allows states to vary from the otherwise strict rules governing state administration of Medicaid. Massachusetts used the waiver to greatly expand coverage to previously uninsured persons, especially through the 1997 and 2005 waivers. The 2002 and 2008 waivers were largely continuation waivers of the prior formulations.

Though Massachusetts had four governors during this eleven year period (Weld, Swift, Romney and Patrick) and all but one of those (Patrick) being a Republican, Senator Kennedy worked diligently, across party lines and with state and national leaders to secure the waivers.

Moreover, Senator Kennedy’s efforts regarding the 2005 waiver were particularly critical to the Commonwealth’s passage of health reform in 2006. Under the 1997 and 2002 waivers, Massachusetts received substantial and extraordinary “supplemental payments” for Boston Medical Center and the Cambridge Health Alliance amounting to about $400 million a year by 2005. In 2004, looking ahead to the 2005 renewal, the Bush Administration indicated their clear intent to end the supplemental payments. Senator Kennedy teamed with Republican Governor Romney to convince the Bush Administration to continue the payments as long as they were used to subsidize insurance coverage for individuals and not used for subsidies to institutions. This became the essential, core formula embedded in the 2006 Massachusetts health reform law.

The Commonwealth’s health reform law has been a extraordinarily successful in meeting its intent. The percent of uninsured has dropped from about ten percent in 2006 to about 2.6 percent in 2008. An estimated 420,000 persons have obtained quality, affordable coverage because of the 2006 law. The 1996-97 waiver led to an expansion in coverage for about 350,000 lower income individuals in the state, especially children. Senator Kennedy used the 1996-97 Massachusetts formulation as his initial model in devising what became the federal CHIP program in July 1997.