Engaging Human Rights Norms to Realize Universal Health Care in Massachusetts, USA

Massachusetts is a national leader in health care, consistently ranking in the top five states in the United States. In 2006, however, only 86% of adults aged 19-64 had health insurance. That year, Governor Romney signed into law An Act Providing Access to Affordable, Quality, Accountable Health Care. By 2017, more than 96% of these adults were insured. The 2006 Massachusetts health insurance reform later became the model for the 2010 federal Patient Protection and Affordable Care Act, also known as Obamacare. This article examines, through a human rights lens, the 2006 Massachusetts health insurance reform 10 years after its implementation (2007-2017) to shed light on the effectiveness of this approach in achieving universal health coverage. Drawing on documentary and interview data, and applying international human rights norms, we found that (1) the 2006 Massachusetts health reform replaced a crisis of uninsurance with a crisis of underinsurance; (2) state leaders in health reform propose widely diverging solutions to the increasing health care costs, the inability of many residents to afford needed health care, and the persistence of medical bankruptcies; and (3) health care is recognized as a human right in Massachusetts, but understanding of the substance or potential of the right is limited.