Blazing the trail for universal health coverage

Taking stock 30 years after landmark state law was passed

THIRTY YEARS AGO today, Massachusetts made history with the passage of the Universal Health Care Law, a triumph that continues to teach us how broad coalitions can win crucial battles and overcome daunting obstacles with time and tenacity.

As two veterans of three decades of health care fights, we can bear witness to the long path that led Massachusetts toward universal coverage.

On April 21, 1988, thousands of people gathered on the State House steps to celebrate the signing of Chapter 23, the Universal Health Care Law, after an intense legislative battle. Then-Governor Michael Dukakis had made universal health coverage a major priority for his administration. With a goal of providing coverage to the 600,000 Massachusetts uninsured residents, the law included a Medical Security Plan, which provided health insurance to workers collecting unemployment benefits, and the CommonHealth program, which provided wrap-around Medicaid-like coverage for children and adults with disabilities. It also included a “play or pay” surcharge assessed on most employers who did not provide health coverage to their workers, designed to go into effect four years after enactment. The legislation was hailed broadly as an important step forward.

Chapter 23 also represented a robust disruption to the dynamics of health reform. Previously, business groups, insurers, hospitals, and elected officials had written health care legislation largely without public scrutiny. But a new health advocacy organization, Health Care For All, led a two-year campaign to change that. Health Care For All created a broad coalition of people without health insurance, individuals with disabilities, parents of children with special health care needs and seniors, all invested in fighting for quality affordable health care. The campaign signaled the emergence of consumers as an important voice and an active player in health policy debates.

Health Care For All’s participation brought transparency to the process and changed the terms of the debate. Its advocacy put access to health insurance on the political agenda for decades and built a strong consumer constituency for reform efforts.

Then, in 1992, after a dramatic shift in the political environment following an economic downturn and the election of a governor who opposed the law, another battle began. But despite the new administration’s opposition, the CommonHealth and Medical Security programs survived and were implemented.

In 1996, Health Care For All went on to successfully organize a new broad-based campaign that led to a new law that expanded health coverage to all children in the state, extended MassHealth to single adults, created a prescription drug program for seniors, and repealed Chapter 23’s surcharge on employers. And thanks to the work of our Democratic Sen. Ted Kennedy and Utah Republican Sen. Orrin Hatch, our Massachusetts precedents became the blueprint for the national Children’s Health Insurance Program (CHIP), which now covers almost 9 million children nationally.

The journey did not end there. Health Care For All and the Blue Cross Blue Shield of Massachusetts Foundation worked with a broad group of stakeholders, including insurers and hospitals as well as Republican Gov. Mitt Romney, to pass Chapter 58 in 2006, the sweeping health-care reform measure that resulted in health insurance coverage for the vast majority of state residents. Massachusetts had become the first state to make health care a right of all residents. Four years later, federal policymakers modeled the 2010 Affordable Care Act after our law.

The successes are clear. Thirty years ago, more than 10 percent of the state’s population was without health coverage. Today, it’s under 3 percent, the lowest in the nation.

Those numbers are not dry statistics. They represent senior citizens who can pay their hospital bills without going bankrupt, sick children who get access to specialists, construction workers and artists and waitresses who do not have to lie awake at night worrying about a terrible choice between paying for medical care or paying the rent.

We are rightly proud of our successes. But we remember that progress did not happen in a straight line or without struggle. It took three waves of state health reform which in turn prompted national reform efforts.

Meet the Author

Rob Restuccia

Executive Director, Community Catalyst
Meet the Author

Andrew Dreyfus

President & CEO, Blue Cross Blue Shield of Mass.
Today, the struggle continues, amid federal efforts to subvert the Affordable Care Act and Medicaid. Are we disheartened? Not at all. We know the stakes and we know who we are fighting for.


Rob Restuccia, executive director of Community Catalyst, is former executive director of Health Care For All. Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts, served in the Executive Office of Human Services in the Dukakis administration and led the Blue Cross Blue Shield Foundation during the battle for universal health coverage.