State health care reform in Massachusetts.

Abstract

O n 24 July 1996 , the Massachusetts legislature voted to provide almost all Massachusetts childrenwith financial access to health care coverage. Chapter 203 of the 1996 Massachusetts Acts restructures and expands the public health care access programs for children. This significant step occurred during a year in which the federal government made substantial cuts to publicly funded programs for children, as well as for certain groups of adults.While the legislation is fairly broad in its reach, the clear emphasis of the legislative debate and ofmedia coverage during its passage was on the expansion of insurance options for children. Although Massachusetts is seen as a “liberal” state, Chapter 203 was by no means assured passage. Democrats maintain substantial majorities in both houses of the legislature, but the Democratic leadership is seen by many observers as fiscally conservative and disinclined to undertake significant new human services initiatives.Moreover, the law’s passage required the legislature to override a veto by the governor, who lobbied strenuously against the legislation because of its imposition of additional cigarette taxes. TheMassachusetts legislationmay provide a blueprint for similar efforts in other states and at the federal level because it involved amelding of good public policy with systematic and strategic attention to the necessary politics.