A Sense of Urgency Creates Opportunity
One of the major reasons Massachusetts was ultimately able to pass their health reforms was the threat of losing significant federal funds that were—at the time—being directed to care for the uninsured. The federal government told state officials that they needed to convert their Medicaid safety net funds into an insurance model or risk losing federal financing for care of those individuals. Reform was viewed as inevitable, so all the relevant stakeholders had an incentive to stay at the table to improve the bill rather than try to defeat it.
Reformers in other states have wondered how to create a similar sense of urgency in their own states and whether reform is possible without a perceived crisis. It remains an open question whether spiraling health care costs and the current economic crisis will create this sense of urgency among state and federal leaders. In any case, states have learned that it is difficult to build and sustain support among affected stakeholders without a sense of urgency or inevitability, because there are so many who are heavily invested in the status quo.
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