Last night, the Massachusetts Senate passed a bill projected to trim $150 billion off state medical costs over 15 years. As the Boston Herald reported, health care spending currently consumes about 40 percent of the state budget and is expected to double by 2020. This legislation, passed by an overwhelming 35-2 vote, aims to reduce that burden by changing the way medical professionals care for patients and taking steps to keep Massachusetts residents healthier:

The bill, which was debated over two days in the Senate and required the consideration of 265 amendments, would seek to limit health care cost growth to a level at or slightly above overall state economic growth.

It aims to achieve that goal by encouraging hospitals and doctors to adopt new care delivery and payment models focused on patient outcomes rather than quantity of care provided, and would transition state-funded health care programs away from fee-for-service to alternative payment systems by 2014.

The Senate has also proposed to invest $100 million over the next five years in a transition to electronic medical records, and another $100 million in wellness and prevention programs paid for with an assessment on insurers.

Celebrating the vote, Senate President Therese Murray said Massachusetts “[o]nce again” leads the U.S. on health care. Moving medical records to an electronic format is expected to reduce administrative expenses, while prevention initiatives could cut health care costs by potentially billions of dollars, reducing the burden on taxpayers without negatively impacting care. A study released last year, meanwhile, found that doctors will improve the quality of care if their performance is tracked.

Leaders in the Massachusetts House have their own version of this bill that differs from the Senate version, including a luxury tax on some high-cost hospitals featured in the House version, which Murray said she would not support. An architect of the bill, Sen. Richard Moore (D), said he hoped “the bulk” of the bill would ultimately become law.

-Zachary Bernstein

Pastor Leonard Cohen protesting in Boston, March 11, 2004.

President Obama’s endorsement of marriage equality this week is a significant milestone in the inevitable arc toward its universality. Though conservatives have expressed outrage, their comments also reflect how much public opinion has shifted in even the last decade.

Consider the four comparisons below. In the left column is how various social conservative spokespeople responded in November, 2003 when the Massachusetts Supreme Court ruled in favor of same-sex marriage. In the right-hand column, see how they (or their successors) responded this week to Obama’s announcement:

The players may not have changed much, but the rules have. There are certainly some conservatives whose anti-gay screeds continue to be explosive, but in general, it seems that changing public opinion has forced them to tame their rhetoric. Less than a decade ago, marriage equality threatened the survival of society, but now it’s just “disappointing” and “a mistake.” It won’t be long before even these timid responses alienate voters who understand that marriage equality is good for communities, good for families, and good for everybody everywhere.

“It would have been impossible for Massachusetts to do what it did without increased federal Medicaid support,’’ said John McDonough, a major architect of the state’s health care overhaul law and now director of Harvard University’s Center for Public Health Leadership.

“What he’s proposing is in direct opposition to what he did as governor,’’ said Amy Whitcomb Slemmer, executive director of Health Care for All in Massachusetts, citing the Bay State’s 98 percent coverage rate, the highest in the nation. “That kind of expansion would not have been possible under a block grant program,’’ as Romney has proposed.

Indeed, Romney funded his 2006 health care expansion by re-appropriating state funds and relying on additional federal Medicaid funding he secured from the Bush administration. As Romney himself explained to Bill O’Reilly in April of 2010, “[F]rom the beginning the plan was a 50/50 deal between the federal government and the state government. The Feds fund half of it, they have from the very beginning.” The Boston Globe notes that “approximately 56 percent of the gain in coverage was related to increased federal Medicaid support” in Massachusetts, and of the newly insured, “18 percent gained coverage through Medicaid, and another 38 percent gained coverage through Commonwealth Care, a program that federal Medicaid dollars pay half of.”

As a presidential candidate, however, the former governor has argued that he could lower federal spending on Medicaid by transferring control of the program to the states and transforming the current matching-rate funding structure into block grants that would pay states pre-determined funding amounts. The “blocks” would not increase with health costs or automatically rise during economic downturns.

According to a Congressional Budget Office (CBO) analysis of Rep. Paul Ryan’s (R-WI) Medicaid block grant proposal — which is very similar to Romney’s — federal expenditures on the program would be “49 percent lower in 2030 than current projected federal spending.” “[T]he magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both,” the Office concluded. “Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased costsharing by beneficiaries—all of which would reduce access to care.”

The Romney campaign released a new campaign ad this morning attacking clean energy jobs. Just like every other ad on the issue this election cycle, this one cherry-picks a few stories and claims that efforts to create jobs in this sector have failed.

As numerous reports have shown, the claims in this ad are completely absurd: The Brookings Institution found that the stimulus helped the clean energy sector grow 8.3 percent during the height of the recession; a report from the Department of Energy showed that the 1603 Treasury Grant Program supported 75,000 jobs and $25 billion gross economic activity; and a recent analysis from the Bureau of Labor Statistics found that the clean economy now employs 3.1 million people — with growth in the last few years happening in every geographic region of the U.S.

And in a masterful piece of spin, the campaign ad actually insinuates that Obama is responsible for 10,000 job losses in the wind industry. Ask anyone in the wind industry and they’ll tell you those jobs have been shed because of Congress’ inability to pass the production tax credit and give businesses in the sector certainty — threatening an additional 37,000 jobs today. In fact, it was the stimulus package that helped the wind industry maintain 85,000 jobs during the height of the recession in 2009.

But here’s the real kicker: There are actually 64,000 renewable energy and energy efficiency jobs currently in Romney’s home state of Massachusetts. Because of strong state and federal policies (which Romney once supported), employment in Massachusetts’ clean energy sector grew 6.7 percent between 2010 and 2011 — crushing the 1% growth rate in the rest of the economy.

Check out the documentary film below to see what’s happening today in Romney’s home state. In just one short election cycle, the candidate has Etch-a-Sketched himself squarely against clean energy — even as the industry gains traction.

But now, he’s brushing off the criticism by insisting that “he was actually taking advantage of the law in Massachusetts that allows children to remain on their parents’ insurance plan until age 24.” “You can do that in Massachusetts, I voted for that,” Brown said. “For (Warren) to call me a hypocrite as to how Gail and I provide for our family, it’s sad,” Brown said, referring to his wife, Gail Huff.

Brown may have taken advantage of Massachusetts reform while serving in the Bay State, but as a senator, he’s benefiting from the ACA’s most popular provision.

According to the Office of Personnel Management’s (OPM) website, Brown’s congressional health care plan (the Federal Employees Health Benefits Plan) is regulated by federal law, not state legislation — “The FEHB Program is a Federal program and preempts state law requirements,” the site says — and the program allows dependents to stay on their parents’ insurance plans until age 26 as a result of Obamacare:

An official at OPM confirmed to ThinkProgress that “As long as the parent has a self-and-family enrollment, dependent children are covered under that enrollment until they reach age 26, as a result of passage of the ACA. Before the ACA, the dependent age was by FEHB law up to age 22.”

The Brown campaign did not return multiple requests for comment.

The tactic surprised some voters, who believed Romney’s campaign pledge to make domestic partner benefits a “hallmark of my leadership as governor,” as he himself seemed to indicate an early willingness to accept the pro-gay ruling:

Then came the Supreme Judicial Court’s ruling in November 2003 that same-sex couples had a constitutional right to marry. In its 4-3 decision, the court gave the Legislature 180 days “to take such action as it may deem appropriate.” Opponents of same-sex marriage — citing a quirk in the state’s colonial-era Constitution that gave the governor authority over matters related to marriage — argued that the court’s decision was not binding and urged Romney to ignore it.

But Romney did not want to trigger a constitutional crisis — seeking, his advisor Flaherty said, to be “respectful of the law and respectful of people at the same time.” Initially, he struck a balanced tone with his two-track move to find a legislative solution that would satisfy the court while corralling support for a constitutional amendment banning gay marriage. “We certainly have to follow the law, and the Supreme Court has laid down what we must do,” he said on NBC’s”Today” show the day after the ruling. “But in my view, the right action is to follow two courses at the same time.”

But the governor quickly dropped all talk about complying with the ruling. Behind the scenes, Romney advisors worked to come up with ways to head it off, according to those involved. They consulted conservative constitutional experts such as historian Matthew Spalding, who works closely with former Reagan Atty. Gen. Edwin Meese III at the Heritage Foundation.

It was soon clear that Romney could not push a gay marriage ban through the state’s liberal-leaning Legislature. So he helped persuade Republicans to support a compromise amendment that barred same-sex marriage but legalized civil unions.

Romney eventually seized on an obscure 1913 law (originally intended to limit interracial marriage) to keep out-of-state couples from marrying in Massachusetts and “endorsed a separate citizens’ petition for an amendment to ban gay marriage. Still, some conservative activists criticized Romney for opening the door to civil unions,” accusing him of being “everywhere on this issue” and even going so far as to claim that he personally issued marriage licenses to gay couples.

By 2005, however, Romney was appearing before conservative groups in South Carolina and declaring, “From Day One, I’ve opposed the move for same-sex marriage and its equivalent, civil unions.” Calling the ruling “a blow against the family,” he said that some gay couples “are actually having children born to them.”

It’s time to take back the narrative about clean energy.

Since the bankruptcy of a few high-profile clean energy companies, political opponents and media pundits have tried to label the entire industry a failure. This is a gross distortion of the on-the-ground reality — and it shows how disconnected people are from what’s really happening in this sector.

The clean energy industry is extraordinarily diverse, ranging from small contractors to massive industrial manufacturers. Recognizing the local value these sectors provide, states around the country are putting policies in place to attract new businesses and large amounts of private capital. And it’s working.

Massachusetts is the perfect example. After signing the Green Communities Act into law in 2008, the commonwealth has seen an explosion of new companies. There are now 64,000 people employed in Massachusetts’ clean energy sector today.

I traveled to the commonwealth with Andrew Satter, our senior video producer at the Center for American Progress, and brought back this piece from the front lines of the clean energy economy.

As counter-protesters — including Occupy Boston Queer and Trans Direct Action Working Group — expressed their opposition to Lively’s participation, one of the speakers said from the podium, broadcast across the loud speakers at the Commons, “We will not be silenced by faggots.” Read a first-hand account from the protester roughed up in the picture at Back2Stonewall. Pictures via Courtney Sacco:

Annual spending for programs affected by Chapter 58 grew from $1.041 billion in fiscal 2006 to $1.947 billion in fiscal 2011, an increase of approximately $906 million. The
state’s share of this spending increase is $453 million, or 50 percent of the total. While critics periodically claim that health reform has been a “budget buster,” additional state spending attributable to the health reform law accounted for only 1.4 percent of the Commonwealth’s $32 billion budget in fiscal 2011. Over the five full fiscal years since the law was implemented, the incremental additional state cost per year has averaged $91 million, an amount that is well within projections made prior to the law’s enactment. [...]

[A]nnual state spending for uncompensated care dropped by $118 million over the first five years of reform. Annual Health Safety Net (HSN) spending fell by one-third from fiscal 2006 to fiscal 2008, reflecting a more than 50 percent decline in the number of inpatient discharges and outpatient visits for which HSN payments were made during that period.

Massachusetts’ success may provide a template for states implementing the national measure, which includes cost control provisions — like investments in comparative effectiveness research, electronic health records, and delivery system reforms — that will result in greater health savings for the nation. But for now, this report is just another example of the contrast between the doomsday predictions of conservatives and the reality of reform.

Romney thanked the Bush administration for approving federal authorizations to fund the law and praised the late Sen. Ted Kennedy (D-MA) for his “essential” work in shaping and advancing the bill through the state legislature. “Special thanks as well to the Heritage Foundation,” Romney continued. “Two of its leading scholars are the ones who helped design and craft what we now call the Connector, which is the centerpiece of the insurance reform portion.” Once Heritage’s Dr. Robert Emmet Moffit took the stage, he praised the law for establishing a new “patient centered” and “consumer-based” market where everyone can find affordable coverage:

MOFFIT (HERITAGE FOUNDATION): We’ve been honored by your request…to participate in giving our best advise and our technical assistance in designing a new and different kind of health insurance market. A market that is patient-centered and consumer-based, which will ease access to affordable coverage for thousands of Bay State citizens. This is new. It’s a new market, where individuals and families will be able to own and control their health insurance and take it with them to from job to job… Nothing like it has ever been attempted anywhere else in the United States. So Massachusetts has raised the bar for every state in the union. And that’s the applause you’ve given to your public officials here today is going to echo far beyond the hallow halls of this historic place.

Watch it:

Since its enactment, health insurance coverage among nonelderly adults in Massachusetts increased to near universal levels, nonelderly adults were more likely to have a usual place to go when they were sick, the state has reported drops in the shares of adults reporting a hospital stay and using the emergency department and seen gains in the affordability of care. More businesses are now offering health insurance and almosts all children can now see a doctor when they need to.

In fact, a new report released yesterday found that “for the second year in a row, the Massachusetts Health Connector’s Commonwealth Care program will provide private health insurance to eligible residents at a lower cost than the previous year.” The state will “save the state approximately $91 million with no benefit reductions or member co-pay increases” as a result of “contract renegotiations with providers and referral management,” said Commonwealth Health Insurance Connector Authority Executive Director Glen Shor. “Several of the insurance carriers achieved significant success in persuading provider organizations to serve Commonwealth Care members at a lower cost.”

According to a WBUR poll from February, 62 percent of Massachusetts residents support Romney’s law, while just 33 percent oppose it.

In response to a inquiry from ThinkProgress about whether or not he believed the “Romneycare mandate [is] constitutional,” Santorum remained circumspect and later refused to answer our follow-up question about repealing the mandate in Massachusetts:

VOLSKY: Senator, is the Romneycare mandate constitutional?

SANTORUM: I think, I’m having trouble hearing questions. But I would just say, whether I believe it’s constitutional. Look, ah, I don’t think, obviously I don’t think that Obamacare is constitutional and I didn’t advocate for a federal mandate at the federal level. I’ve always been for free market health care, not for government-run health care.

Watch it:

Conservatives have argued that the federal requirement violates the rights of the states, but few have claimed that states shouldn’t regulate their citizens’ behavior in the health care marketplace or that state laws are forbidden from mandating the purchase of a particular product like automobile insurance.

Santorum did oppose Gov. Rick Perry’s (R-TX) state mandate requiring women to receive HPV vaccines, describing it as “having little girls inoculated at the force and compulsion of the government.”

Rick Santorum campaign sign

As the New Yorker’s Ryan Lizza, who obtained the memos, notes, “one of the few significant policy disagreements” between Obama and Hillary Clinton during the 2008 primary campaign “was whether or not to include such a mandate in a health-care plan.” Clinton supported it, Obama initially opposed it. But after hearing from his advisers, Obama changed his mind, concluding that the mandate was necessary.

An April, 2009 briefing memo from senior White House health policy adviser Nancy-Ann DeParle lays out “a set of savings and revenue options” for health care, including the mandate. Under a section called “Individual Requirement for Health Insurance,” DeParle makes the case for the mandate by citing the Massachusetts law passed by former governor Mitt Romney as a positive example:

Because of concerns about the impact of the individual requirement on middle income families, we have explored coupling an individual requirement with an exemption process for those for whom coverage remains unaffordable. In Massachusetts, taxpayers are exempt from the mandate-associated penalties if the lowest premiums available to them exceed a certain fraction of income (for example at $60,000 of family income, families are excused from penalties if premiums exceed $4,400—about 7 percent of income). There is an additional waiver process that allows people to claim a hardship exemption from the penalty on a case-by-case basis if they have special circumstances.

This is the only time any state is mentioned in the seven page memo.

Meanwhile, it’s already known that senior White House officials — including Obama himself — had a dozen meetings in 2009 with three health experts who helped shape Romney’s law. “They really wanted to know how we can take that same approach we used in Massachusetts and turn that into a national model,” said MIT economist Jon Gruber of a July meeting.

Romney’s health care law has become a major campaign issue, with challenger Rick Santorum rallying in front of the Supreme Court today to say that he is the only candidate in the GOP presidential primary who can draw a contrast with Obama on this issue, because Obama’s law is based on Romney’s.

Indeed, the laws bear many similarities.

During an event this morning in Louisiana, Romney told at least three whoppers. The former governor said that a recent Congressional Budget Office report concluded that the costs of the law have doubled, cited a discredited study claiming that 30 percent of employers will stop offering insurance as a result of the law, and insisted that the Catholic Church would be required to offer birth control to its employees:

– ROMNEY LIE 1: “And we’ve just learned from the CBO, it’s not a trillion dollars. It’s more like double that…Obamacare is massively more expensive than had been originally estimated.”

– ROMNEY LIE 2: “Thirty percent of employers said they are going to drop the coverage for their employees when Obamacare is installed.”

– ROMNEY LIE 3: “The Catholic Church is being told that they have to provide insurance that covers morning after pills, sterilizations, and contraceptives. Despite the fact that these very features violate the conscience of the Catholic Church itself.

Watch it:

But he’s wrong — dead wrong on all three points. In a report released last week, the CBO actually found that the Affordable Care Act was expected to cost $50 billion less than they anticipated a year ago. Romney is twisting the results by referring to the gross cost of the legislation for 11 years ending in 2022 — $1.76 trillion — and comparing it to the original cost estimate of $938 billion over 10 years ending in 2019. As FactCheck.org explained, “The 11-year figure is much higher because it includes three additional years of full implementation of the coverage provisions of the law.” After accounting for the law’s offsets, the “net” cost of the coverage provisions are “expected to be somewhat lower than projected two years ago. Comparing the eight years that are common to both estimates, the net cost is now predicted to be $772 billion, or about half a percent lower than originally estimated.”

Romney’s claim that 30 percent of employers will drop coverage comes from a study conducted by McKinsey, which after stirring much controversy, promptly walked back its projection. McKinsey stressed that the report “was not intended as a predictive economic analysis of the impact of the Affordable Care Act. Rather, it captured the attitudes of employers and provided an understanding of the factors that could influence decision making related to employee health benefits.” The CBO projects that 3 to 5 million employees may lose coverage, while surveys of employers have found that the vast majority of businesses will continue to offer insurance to employees when the law’s insurance exchanges start up. In fact, if Massachusetts’ health reform is any indication, employers are highly unlikely to dump employees into the exchanges.

Finally, as Romney well knows, the Catholic Church — and all houses of worship — are specifically exempt from the rule requiring employers to provide preventive services like contraception to their employees. Yet he continues to repeat the lie incessantly, suggesting that he’s willing to say anything to appeal to the conservative base and win the election.

“As a result of the president’s all-of-the-above energy strategy, domestic oil and gas production has increased each year and our dependence on foreign oil is at a 16-year low.”

“In Massachusetts, Gov. Romney raised the gas tax by 400 percent. Now Mitt Romney rolled out a tax plan that continues to charge taxpayers $4 billion a year to subsidize oil and gas companies making record profits and he opposed raising fuel economy standards, which will save consumers an average of $8,000 per vehicle.”

LaBolt then took to his Twitter, providing a link to an article on tax reform by Greg Mankiw, a Romney adviser Harvard economics professor, who was once the chairman of the Council of Economic Advisers for President George W. Bush. In the article, published January 21, 2012, Mankiw advocated a tax on gasoline exceeding $2 a gallon.

LaBolt’s comment is misleading — Romney did not raise the 21-cent state gas tax at all, but did increase a 0.5 cent clean-up tax to 2.5 cents, and then diverted the money to the general budget, BuzzFeed explains:

Romney actually increased the price of gasoline directly himself. In 2003 Romney increased fees on drivers by two cents a gallon to pay for environmental clean ups of leaking underground gas station fuel tanks. The fee increased the clean-up tax on drivers by 400% and hit consumers directly at the pump. The fund, which was originally only half-a-cent, was created in 1992 to aid gas station owners with clean-ups. Two weeks after raising taxes on drivers, Romney eliminated the fund for gas station clean-ups entirely but kept the two cent increase in the tax gas. The money raised by Romney’s tax increase now goes directly into Commonwealth’s coffers for legislators to spend as they please.

The issue of gas taxes has been a proven vulnerabilty for Mitt Romney in the past. When running against Sen. John McCain (R-AZ) for the Republican nomination in 2008, Romney’s campaign took a bruising for the gas fee he imposed on the state of Massachusetts:

McCain campaign communications director Jill Hazelbaker responded to a Romney attack on McCain over energy issues by saying, “Mitt Romney has proven in this campaign that he will say anything to anyone at any time if he thinks it will help him politically. … As governor, Mitt Romney effectively raised gas taxes on every single motorist in Massachusetts.”

Governor Romney’s efforts to raise Massachusetts gas taxes — like his support for regulations on coal plants, the Northeast’s cap-and-trade initiative, and green energy — were progressive policies that helped improve the welfare of Massachusetts citizens. The eroding rate of gas taxes in this country has meant that more and more money flows from the 99 percent of drivers to the 1 percent involved with oil companies and Wall Street speculators. Meanwhile, the transportation infrastructure that people depend on is crumbling into disrepair. Burned by a previous attempt to restore the state gas tax from its eroding position, current Gov. Deval Patrick (D-MA) is refusing to restore the gas tax enough to preserve critical public transit services for his state.

– Fatima Najiy

Obama also predicted that the Supreme Court — which is scheduled to hear oral arguments on the constitutionality of reform on Monday — will uphold the law and that “it will be very hard for any governor to explain why it is that they’re not giving people…an opportunity to get cheaper health insurance, better deal, more protections because of some ideological argument that they’re having with the president.” “And when people see that in fact it works, it makes sense — as it’s, by the way, working in Massachusetts — then I think a whole bunch of folks will say ‘Why aren’t we trying it as well?’” he added. Listen: