Massachusetts Rationing Shows What’s Coming to America Under Obamacare

National   |   Burke Balch, J.D.   |   Nov 6, 2013   |   6:54PM   |   Washington, DC

President Obama is holding up the Massachusetts health care law as a good precedent for what Obamacare will bring when fully implemented. It’s a good precedent, all right–for the rationing now under way in the Bay State that the national law will all too soon impose on the entire country.

In an October 30, 2013, speech in Boston’s Faneuil Hall, the President claimed, “[A]ll the parade of horribles, the worst predictions about health care reform in Massachusetts never came true. They’re the same arguments that you’re hearing now. . . . [I]t’s easy to scare folks. And it’s no surprise that some to the same folks trying to scare people now are the same folks who’ve been trying to sink the Affordable Care Act from the beginning.”

At the National Right to Life Committee, we only regret that we weren’t able to scare enough people to prevent enactment of the Massachusetts law and Obamacare – because if we had, those in Massachusetts wouldn’t be facing rationed health care today and the whole nation wouldn’t be on the way to facing worse and worse rationing in coming years.

What happened in Massachusetts? We warned from the beginning that over-promising plus under-funding forces rationing. In 2006, Massachusetts passed a mandate for universal health insurance, with subsidies to enable the low-income uninsured to afford it. To pay for the subsidies, the state law cobbled together a series of funding sources, including federal payments, existing state funds for health care for the uninsured, and other sources of revenue, none of which were based on what people actually pay for health care.

We repeatedly said that without an adequate, sustainable funding mechanism to pay for the entitlement, the state would wind up imposing limits on treatment – rationing. (For a 2009 presentation at the Massachusetts Citizens for Life Convention reiterating and explaining this prediction, see here.)

By 2010, facing a mounting gap between the cost of subsidies and the available revenue, Governor Deval Patrick sent a bill to the state legislature with sweeping measures to limit what Massachusetts citizens would be allowed to spend to save the lives of their family members.

The law ultimately enacted that year authorized Massachusetts to limit what individuals and those employed by small businesses were allowed to spend for their health care. In an October 17, 2011, New York Times article, Patrick was quoted as saying, “We have shown the nation how to extend care to everybody, and we’ll be the place to crack the code on costs.”

The article indicated proponents of the law were candid: “Those who led the 2006 effort to expand coverage readily acknowledge that they deferred the more daunting task of cost control for another day. It was assumed then that the politics would pit doctors, hospitals, insurers, employers and consumers against one another, and obliterate the fragile coalition behind the groundbreaking coverage law.”

A more sweeping Massachusetts bill was enacted in 2012, extending controls to all nongovernmental health care spending. It sets ceilings on what Massachusetts residents are allowed to spend on health care so that between 2018 and 2023, health care spending is to be held below state economic growth by .5 %, a limit drastically below the rate of medical inflation. For enforcement, state bureaucrats are given broad regulative powers.

As Josh Archambault wrote in a February 25, 2013 Health Affairs blog entitled, “Now For the Rest of the Story on Massachusetts Cost Control,” state authorities must “authorize any change to the health infrastructure, and approve or disapprove any new and innovative medical technology. The state health plan will be linked to a strict certificate of need process that requires five different state agencies to grant approval. . . .”

While the treatment-limiting regulations are only beginning to bite, according to the October 25, 2013, Boston Herald, the Massachusetts Medical Society reports that there is a “wait time from 50 days to 128 days in some areas for new patients to see an internist.”



It was apt for President Obama to compare his signature legislative achievement to the Massachusetts health care scheme. For Obamacare also sets strict limits on what people are to be allowed to spend to save the lives and health of their family members, if slightly less draconian ones than those in Massachusetts. (See

Both laws rely on bureaucratic micromanagement that minutely dictates what treatment will and will not be allowed to be available. And both will result in patients losing access to life-saving medical treatment through what amounts to direct and indirect rationing of health care. Note: Burke J. Balch, J.D., is a pro-life attorney and the director of National Right to Life’s Robert Powell Center for Medical Ethics.