Today we celebrate the 20th anniversary of the landmark Massachusetts health reform passed by the Legislature and signed into law in 2006 by then-Governor Mitt Romney, that served as a blueprint for the Affordable Care Act. The number of Massachusetts residents without health insurance dropped by 70% within only two years– and we still boast the highest coverage rates nationwide today.
Health Care For All (HCFA) was proud to play a key role in designing, advocating for, and ultimately implementing the law. Once Chapter 58, sometimes now called RomneyCare, was passed, HCFA’s HelpLine and Community Engagement teams mobilized to help people across Massachusetts understand their new coverage options, apply for insurance, and finally access the care they needed.
HCFA Senior Director of HelpLine & Public Programs Hannah Frigand saw first-hand how Chapter 58 transformed people’s lives. She began working on HCFA’s HelpLine before the law’s passage, back when most callers had few if any options to get care, and vividly remembers their sense of relief once they did.
We sat down with Frigand to reflect back on the impact of Massachusetts health reform, how it shaped HCFA’s direct service and community engagement work, how it influenced the trajectory of her own career, and how it feels to see these hard-won gains threatened in the wake of federal cuts.
When Chapter 58 was signed into law in April 2006, HCFA went from getting less than 10,000 calls a year on our HelpLine to nearly 40,000 calls. What was that shift like, and how did HelpLine counselors support those callers?
Many of the callers had been uninsured for a long time and weren’t even familiar with having health insurance. Before Chapter 58, the HCFA HelpLine felt almost like a resource center, because sometimes all we were able to offer people was a list of insurance plans to call, or information about limited safety net programs. After Chapter 58, we were suddenly able to have a real impact by actually getting them onto health insurance. HCFA had to scale up fast to meet everyone’s needs – at the time, you still had to apply for insurance via mail or fax and wait to hear back for a determination, so we helped people through that process. We had seven interns helping us organize callers’ applications by coverage eligibility date, and we followed up with every single person to make sure everything got squared away. It just meant so much for them to be able to access services for the first time in so long.
How did callers react to finally getting coverage?
Lots and lots of tears! Lots of people were really happy and grateful. It really does change your life even to just have that sense of security to know you can get care when you need it or take your family members to the doctor.
Can you remember any particular conversations that stuck with you?
I remember one woman who had been sick for a long time, but had never been able to get a diagnosis because she didn’t have coverage. We were able to get her onto what would now be called ConnectorCare coverage, and she found out she had MS, and was able to better understand how to manage her condition and get treated. That wasn’t an unusual type of call for us – back then, there were lots of people who knew something had been going on with their health, but couldn’t address it until they got insurance. We had cases where people got cancer diagnoses that could’ve been caught sooner, but could now be treated thanks to this law.
You were on the frontlines of the implementation of one of the most consequential state laws of the 21st Century. What did you learn from the experience?
I learned how important the implementation phase really is. You can pass a great big law, but then you need to know how you’ll make sure people understand what it means for them, how you’ll have them enroll, what the administrative barriers are, and how you’ll help people overcome them. And for all of these things, outreach and community engagement is key – you need to have helpers to educate people and get them onto these great public programs. I remember one time, a MassHealth printer broke and they accidentally sent out blank mailers – and multiple members raised this on the HelpLine so we alerted MassHealth to an issue that they were able to resolve. Having an outreach and enrollment structure that allowed feedback made it easier to fix hiccups.
How did this experience shape your career plans?
Well, I was always interested in public policy – but I didn’t know that I was going to become so passionate about helping people directly. I began to realize that I really valued my time on the HelpLine, and being able to recommend fixes for whatever barrier someone was experiencing. I came to see direct service support like the HelpLine as a way to connect the dots and make sure laws are really working for people.
HCFA’s HelpLine was able to deliver such an exciting message of hope back in 2006. But 20 years later, we’re now seeing many of those gains being clawed back. Recent reports estimate that 300,000 Massachusetts residents could soon lose coverage in the wake of federal cuts. What is it like watching this happen, and speaking to callers?
It’s devastating – we’ve made so much progress through the decades, and it feels like we’re watching the access we’ve built slip away. It’s just so unnecessary. You can feel the hurt when you talk to people – it’s like you’re just abandoning them. And it’s so hard to reconcile that with all we’ve been through, and all the ways we’ve seen people benefit from having health coverage. It hurts so much to think about the people who have already or are at risk of losing access to care, and what will happen to them. Many of them still remember how bad things were before they got coverage. I can’t stop thinking about it.
What role can Massachusetts play to blunt the pain of these cuts?
So, I think continuing the Connector Care expansion is something that’s really helpful, because many people we’re hearing from now are just over the income limits to get meaningful subsidies. Massachusetts can also explore ways to make some subsidies available for other populations who will lose coverage, like lawfully present immigrants. And of course, we can continue to support outreach and education to make sure we’re helping everyone access whatever is available to them.
Ultimately, Massachusetts has a lot to be proud of when it comes to health coverage. Now, we have the opportunity to protect those accomplishments.
Hannah Frigand is HCFA’s Senior Director of HelpLine & Public Programs.
