Casualties of Obamacare Fight to Meet in Massachusetts Governor’s Race

Candidates bear scars from the most bitter policy fight of the Obama era

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Martha Coakley
Steven Senne / AP

Massachusetts Attorney General Martha Coakley faces reporters outside Morin's Diner, in Attleboro, Mass., Monday, Sept. 16, 2013.

Martha Coakley and Don Berwick have at least two things in common: They’re both Democratic candidates for governor of Massachusetts and they’re both casualties of the Republican war on Obamacare.

Coakley, Massachusetts’s attorney general, lost a 2010 special election to fill the U.S. Senate seat left vacant by the death of Ted Kennedy. She was widely assumed to be a shoe-in for the post, but lost to Republican Scott Brown in a race considered a proxy for the political battle raging over the health care law shortly before it passed in mid 2010.

Berwick, a pediatrician and long-time health policy expert, drew fire from the same Affordable Care Act (ACA) opponents when President Obama nominated him to head the Centers for Medicaid and Medicare Services in 2010. A consultant to Britain’s single-payer National Health Service, Berwick was unfairly labeled a proponent of heartless rationing. To avoid a messy confirmation, the White House eventually installed Berwick in the post via a recess appointment, but he left the job in December 2011 when the appointment expired.

(MORECoakley Launches Mass. Gov. Bid)

The Massachusetts gubernatorial race could provide both Coakley and Berwick a shot at political redemption—if the candidates can escape the long shadow of Obamacare. The Massachusetts governor’s race will kick into high gear against the backdrop of the ACA’s first year of full implementation. While Obama Administration officials insist the law will fall into place neatly and quickly become more popular, public confusion is likely and Republican critics will be looking for snags they can cite as evidence the law is dysfunctional.

Massachusetts residents are already familiar with how health care reform works. The state passed launched its own version of reform in 2007 similar in design to the ACA. And the state law, by some measures, functions well. Massachusetts has lowest uninsured rate in the country at 4 percent. (The national rate is 16 percent.) But health care spending per capita is 16 percent higher in Massachusetts than the national average, according to a May 2012 report by the non-partisan Kaiser Family Foundation, and individual insurance premiums are higher there than in any other state. As attorney general, Coakley supported legislation signed into law in 2012 that state officials say will reign in costs.

(MORERate of Uninsured Americans Steady Despite Obamacare)

Health care is big business in Massachusetts. It’s the largest employment sector in the state, accounting for one of every six jobs. Coakley and Berwick aren’t the only candidates with pasts partly defined by the industry. Biotech executive Joseph Avellone is also running in the Democratic primary; United Independent Party candidate Evan Falchuk is vice chairman of a medical research firm. The winner of the Democratic primary will likely face off against Republican Charles Baker, the former chief executive of the Massachusetts insurance company Pilgrim Health, who lost in 2010 to incumbent Governor Deval Patrick. (Patrick has decided not to seek a third term.)

The race for to be Massachusetts’s 72nd governor is still in its infancy, but Coakley is the most well known Democrat in contention and a clear front-runner. To win, she will need to replace the impression state voters have of her from her 2010 loss, which a senior Democratic official told Politico at the time was “one of the worst debacles in American political history.” Coakley was criticized for taking the race for granted and ignoring the kind of retailing politicking that led Brown to victory.

While Brown was known for traveling around the state in his pickup truck meeting voters, Coakley’s public appearances during her campaign for the U.S. Senate had a “subdued, almost dispassionate” quality, according to the Boston Globe. She famously dismissed the idea of shaking hands with voters outside Fenway Park, as Scott Brown was seen doing in an online video. This time around, Coakley seems determined to leave voters with a different impression. In a video announcing her candidacy for governor, Coakley is seen shaking hands with voters on the street and acknowledging her 2010 defeat, saying, “I know what it’s like to lose a race.”

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Berwick may face an even steeper climb with voters. According to a May survey by Public Policy Polling, just 17 percent of Massachusetts voters said they were familiar with Berwick, who has never before sought or held elected office. In campaign finance filings reported on Sept. 15, Berwick had $274,084 cash on hand, about the same as Coakley, who announced her formal candidacy the day after.

In world of health care policy, where Berwick has a strong reputation and is respected by wonks of all political affiliations, the physician is not known for having the kind of aggressive ego-driven personality that defines some candidates. He admitted so in a 2006 interview with U.S. News & World report, telling the magazine:I don’t feel like a leader, so it’s very hard for me to project myself into that situation. But inattention to detail is my biggest defect. I’m always leaning forward into something new. I can create a mess. Luckily, I have people who are willing to create the detail around the idea or, if they’re really smart, know which ideas to ignore.

The second defect is more personal uncertainty than you would probably believe. Every time I put an idea out, despite my enthusiasm, I’m very, very unsure about whether it’s OK or not. And the third is that I want everyone to like me, and yet I’m aware that when you’re pushing for change, that isn’t always going to happen. To be more effective as a leader, I would probably want to thicken my skin.

There may be no better environment to develop thick skin than the bruising fights over health care reform. Next year’s governor’s race, which one pollster called “wide open,” will prove whether Berwick and Coakley have that in common as well.

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