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January 20, 2010, 9:08 am

Supported by Brown, Mass. Health Plan Was a Model for Democrats

Senator-elect Scott Brown, Republican of Massachusetts, said in his victory speech that he is anxious to get to Washington and start his new job. But Mr. Brown, who owes his victory to independent voters, will quickly find himself at the center of a partisan typhoon over the fate of the major health care legislation.

At this victory speech, the crowd chanted “Forty-one! Forty-one! Forty-one!” — a reference to Mr. Brown’s role as the 41st Republican senator, which will deny Democrats the 60 votes that they need to overcome Republican filibusters and advance legislation, including the health care bill.

And Mr. Brown has promised to do just that — to block the health care legislation and force Democrats to start over. In an interview last week on Fox Television, he said: “Literally right now I could be the 41st senator. I can stop the debate and bring them back to the drawing board, because right now it’s broken and people throughout the country have lost faith in the process.”

But given that he must rely on independent voters in the heavily Democratic state of Massachusetts, Mr. Brown, who will be up for re-election in 2012, may find political peril in becoming the high-profile 41st foot soldier in the Senate Republicans’ battle against the health care legislation.

The health care bill is President Obama’s top domestic priority, and Mr. Obama remains popular in Massachusetts.

While the Republican leadership will be looking to him to help deal Congressional Democrats a crushing defeat, Mr. Brown may have to choose between backing the leadership or working with Senator Olympia J. Snowe, Republican of Maine, on a potential health care compromise. Ms. Snowe approved the health care bill developed by the Senate Finance Committee but turned against the measure when Democratic leaders made changes.

Often Ms. Snowe’s efforts to reach an agreement with the Democrats seemed like a lonely venture, and she would presumably welcome Mr. Brown’s involvement. And with virtually every American now holding a stake in how Mr. Brown votes, his own record on health care issues in Massachusetts is likely to come under intense scrutiny.

Mr. Brown, as a state senator, voted in favor of the Massachusetts universal health care law in 2006, when the state became the first in the nation to pass a far-reaching overhaul guaranteeing coverage for nearly every state resident and requiring everyone in Massachusetts to obtain insurance.

Mr. Brown, in campaigning against the health care legislation emerging in Washington, has sought to portray it as fundamentally different from the Massachusetts plan. But Massachusetts was actually an important model for what Congress has developed, arguably the model for what Congress envisions.

The federal law, like the one in Massachusetts, is built around a system of government-subsidized, private insurance coverage with subsidies on a sliding-scale based on income. The federal law, however, also includes a number national steps aimed at controlling health care costs, and new taxes and fees aimed at paying for the legislation. Massachusetts has continued to struggle with its costs.

Mr. Brown’s predecessor, Senator Edward M. Kennedy, who died in August of brain cancer, was the chairman of the Senate health committee, and ahead of the push for a national health care overhaul he hired or consulted with many of the people who designed the Massachusetts plan. Among those brought on staff by Mr. Kennedy was John McDonough, the former executive director of Health Care For All, a Boston advocacy group, and a leading architect of the Massachusetts plan.

Jonathan Gruber, an economist at the Massachusetts Institute of Technology and a major supporter of the Massachusetts plan, has been a close adviser to the White House on the health care legislation.

The online marketplace, or exchange, where Massachusetts residents can shop for health insurance was a model for the exchanges included in the House and Senate versions of the health care legislation.

And the Massachusetts experience in setting up and running the exchange has been an important model for Congressional Budget Office analysts as they calculate the potential costs of the health care legislation and its implications for expanding health coverage.

So as Mr. Brown gets ready to head to Washington, he can expect to be pressed on exactly what he views to be the differences between the Massachusetts plan and the legislation developed by Democrats in Washington.

He’s already given some hints. Here’s an excerpt from an interview on the Fox network in which he explained his vote in favor of the Massachusetts universal health care bill, which was signed into law by Gov. Mitt Romney, a Republican who ran for president in 2008 and is considering another run in 2012.

“Yes, I voted on it,” Mr. Brown said. “It was a bipartisan effort, because we were paying almost a billion dollars to the hospitals for people were just walking in and getting free care.”

Asked if that means he now opposes a policy he once supported, Mr. Brown pushed back.

“That’s not true. They are two different programs. What we have here is a free market enterprise where we are providing insurance in various levels to people in Massachusetts. The plans in Washington are a one-size-fits-all plan that’s going to cost almost a trillion-plus dollars, raise taxes, at a time when we don’t need it. Why would we subsidize, and why would we pay more for something we already have? It makes no sense.”

But many experts say Massachusetts, where health care costs have continued to climb in recent years, stands to benefit heavily from a nationwide health care overhaul, largely because it would no longer be one of the only states to guarantee coverage, not to mention that the federal government would subsidize coverage for moderate-income people in Massachusetts that now get subsidized coverage from the state.

Mr. Brown’s suggestion that he would force Democrats to start over — “I can stop the debate and bring them back to the drawing board, because right now it’s broken and people throughout the country have lost faith in the process” — drew an angry response on Monday from the House speaker, Nancy Pelosi.

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