‘Happiest day of my life’ for Ferguson, architect of ‘Chafeecare’

Ferguson (r) with Costantino and Roberts

“Is this the happiest day of my life? Pretty much!”

That’s what a smiling Christine Ferguson told me at a press conference this morning when I asked how it felt Thursday to see the health policy she developed as a senior aide to the late U.S. Sen. John Chafee upheld as constitutional by the U.S. Supreme Court.

Ferguson, who started working for Chafee’s son on Monday as head of Rhode Island’s new health insurance exchange, said unequivocally that President Obama’s signature accomplishment is what she drafted for Republicans two decades ago. “It is based on the John Chafee bill of 1993,” she said. “It is pretty much exactly how we envisioned it.” She added: “I think it’s a great day.”

Ferguson was a key architect of the Health Equity and Access Reform Today Act of 1993, introduced by the senior Chafee that year as the Republican alternative to the Clinton administration’s so-called “Hillarycare” proposal. (Oddly enough, Hillary Clinton’s 1993 proposal was crafted in partnership with a Rhode Islander, too – Ira Magaziner of Greenhouse Compact fame.)

Bill Clinton and Ted Kennedy, among others, would come to rue Democrats’ failure to reach a compromise in 1994 along the lines of Chafee’s bill. But it still influenced future policies, notably the Kennedy-Kessebaum Act (also known as HIPAA) and Hillary Clinton’s 2007 health care proposal – not to mention the 2005 Massachusetts law signed by Gov. Mitt Romney, whose commissioner of the Mass. Department of Public Health was Ferguson.

Ferguson lamented that Republicans – including Romney – don’t see Obama’s law the way she does.

“I think it’s sad that the Republicans have flipped around so much on this, and I wish that they would understand that health care is such a core value of ours as a country, that they should be more be comfortable working on this issue,” she said. “But it’s been able to be politicized since the 1960s, really, and both the Democrats and the Republicans have politicized it. … Both parties are kind of at fault, from my perspective.”

She added: “I think a lot of those Republicans, and a lot of those Republican governors who really have to make those balanced budgets at the end of the year across the country, in two years are going to be saying, ‘Oh my God’ – in private – ‘this is really a great thing; it’s helped us do so many things.'”

Democrats U.S. Sen. Jack Reed and Providence Mayor Angel Taveras also tipped their cap to John Chafee in celebratory statements Thursday. “Nearly two decades ago, former Republican Senator John H. Chafee pointed out that a private health insurance market works best when everyone is in the insurance market,” Reed said.

Of course, Obamacare has critics on the left, too – liberals who argue a simpler way to expand health coverage would be to make all Americans eligible for Medicare, which currently covers only those ages 65 and older. Ferguson paused for a long time when asked why the complicated Affordable Care Act is a better approach than that.

“Having run government agencies that do health care and … working on Medicare issues, there are real advantages to having other entities like insurance carriers involved in this,” she finally replied. “It allows for some choice and it allows people, both the government and individuals, to say: ‘Look, we don’t like the way you’re doing this and we’re going to go somewhere else.’ And when you remove that capacity, you tend to spend less and be less focused on innovation and really moving forward.”

“Right now I think you’re seeing the private sector really lead the public sector on a lot of delivery system reforms in Medicare – Medicare is picking up what the private sector is doing, not the other way around,” she continued. “I think you have to have a really good balance between the two, and it’s a fine line – that balance is always a fine line. But I think that we’re striking it, and I think in Rhode Island we have been doing a really good job of striking that balance, and will continue to do so.”

Lt. Gov. Elizabeth Roberts, the Democrat whom Governor Chafee tasked with implementing the health law in Rhode Island, said the state has had a bipartisan consensus on many aspects of health policy over the years even as Democrats controlled the legislature and Republicans usually controlled the governor’s office.

“This has not been an overly partisan issue in Rhode Island,” Roberts said. “We have had a broad agreement that we needed to solve our health care challenges, and that has given us a consistency of effort.”

• Related: How John Chafee paved the way for ‘Obamacare’ in the 1990s (March 23, 2011)

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