The defeat of a ballot initiative that would have given Massachusetts residents universal healthcare likely won't be the last time the state debates such a measure.
But how quickly similar measures appear and in how many other states will depend in large part on the economy, says Nancy Turnbull, an instructor of health policy and management at Harvard University. If the economy takes a downturn, more people will be uninsured as employers look to cut costs and benefit packages.
"The problem of the uninsured is not going away . . . There's definitely growing attention to the problem," Turnbull says. "It's a sad commentary but a realistic one that until it is people who vote who are uninsured, who feel their coverage is insecure, we don't have attention on these issues."
Despite polls a few days before the vote that placed support for the initiative known as Question 5 at or above 50%, undecided voters appear to have been key.
Unofficial results put the vote totals at 1.246 million against Question 5 with 1.127 million people voting for the initiative.
If passed, Question 5 would have overhauled the state's healthcare system. The initiative would have prohibited the conversion of not-for-profit healthcare entities to for-profit, banned HMOs from doing business in the state and allowed patients to choose any physician to care for them.
"I don't think (the defeat) signaled any dwindling of commitment on the part of advocates and most of the voters to universal coverage," Turnbull says.
Opponents of Question 5, including the state's health plans and medical society, spent millions to defeat the measure. Supporters spent about $50,000.
Proponents argued that all Massachusetts residents deserve healthcare and that the current system discriminates against the poor. Opponents argued that while there are issues that need to be resolved in the healthcare system, the proposal went too far, didn't have a concrete plan for how the new system would work and contained no plans on how to fund a universal healthcare system.
"There were lots of us who had concerns about the initiative (including) many of us who have been . . . spending our careers working for universal coverage," says Turnbull, who was part of a coalition to defeat the initiative.
A large part of the defeat came down to money, says Andre Guillemin, campaign director for the Ad Hoc Committee to Defend Healthcare, which supported the measure.
"We were outspent 100 to 1 in this campaign. Five million dollars of patient care money was spent to block healthcare reforms," he says.