At the recent annual meeting of America’s Health Insurance Plans in San Diego (dubbed Institute 2006), it became clear to me why a conservative Republican like Mitt Romney was elected governor of Massachusetts, which is widely credited to be the most liberal state in the Union.

Romney, keynoting at the AHIP meeting about the recently passed universal health plan in his state, is silky and photogenic–like a movie version of what a governor should be. You can visualize thousands and thousands of voters who might disagree with his views saying they’re willing to forget all that just to have him representing the state as its head of government because he looks so good. But he’s obviously got some substance, too.

In any case, Romney was refreshingly forthright on how the program came about. “I didn’t plan to have this plan,” he said. “I thought it was impossible.” But then someone whose advice he valued told him, ‘If you want to help people, find a way to get them health insurance.’

Massachusetts was facing the same health insurance problems most states face: double-digit annual increases in premium; half a million people uninsured; many small businesses dropping health insurance; and significant barriers to individuals and small businesses who want to buy coverage.

Adding pressure to finding answers to these conditions was that the state was in danger of losing a Medicaid waiver that brought in funds to the tune of $385 million. So, it had to come up with a way to prevent that loss, the governor said.

The state also had something that most other states don’t: Hospitals are mandated to provide emergency care, which is costing something close to $1.2 billion a year. The state has been collecting about $1 billion a year that goes into a pool to reimburse providers who give free care.

In what must have been an ‘aha’ moment, Romney said his team thought, ‘If we’re already paying for care, can’t we get these people health insurance?’

We’ve already reported on many of the details of this program that Romney and the Democratic legislature hammered out between them.

What I was impressed with at seeing Romney in person was how he conveyed the state’s seriousness of purpose.

For instance, when the team analyzed the uninsured in the state, one of the major sectors it found was people who were eligible for Medicaid but never signed up, some 106,000 people.

These people were costing Massachusetts a fortune in free care without the benefit of the state getting any reimbursement from Medicaid. So, a very proactive outreach program was put into place that resulted in 77,000 of these people being signed up in the last six months, Romney said. A terrific result any way you look at it!

One thing that is worrisome for observers is that Romney won’t be running again and his term ends just as the program is about to get off the ground. Will the next governor and/or legislature implement it as enacted or start tinkering immediately?

For my part, I hope the program works. Granted, it has a lot of moving parts that are going to have to click for it to do what it’s supposed to do. But it is a creative approach to what mildly can be described as a stubborn problem. And it shows what can be achieved when people reach across the political aisle in the search for solutions rather than talking points.

Washington, take note.

Steve Piontek

Editor-in-Chief