by CommonWealth Beacon staff, CommonWealth Beacon
April 13, 2026
EPISODE INFO
GUESTS: John McDonough, professor at Harvard’s TH Chan School of Public Health; Cheri Andes, former Greater Boston Interfaith Organization lead organizer
THE ROAD TO THE landmark health care access law Massachusetts enacted 20 years ago is dotted with milestones that are familiar today.
This week on The Codcast, John McDonough, a professor at Harvard’s TH Chan School of Public Health, moves from the co-host chair to the guest chair for the latest installation of Health or Consequences, where he joins former Greater Boston Interfaith Organization lead organizer Cheri Andes for a reflection on the grassroots campaign that led to “Romneycare.”
In the years leading to the 2006 breakthrough, policymakers were feeling a sense of crisis because of impending federal funding cuts to the state’s Medicaid program, McDonough recalled, as he and Andes were interviewed by Health or Consequences co-host Paul Hattis. Advocates launched a multi-year campaign targeting 2006 as the pivot point for action, and to boost their leverage, they also collected signatures to put a health care access question on that year’s ballot — that way, if lawmakers failed to find consensus on the thorny issue, voters would have a chance to force through reforms anyway.
McDonough, a former state representative, said it had become clear that ballot questions could be proposed “not so much to win a law on the ballot, but to use the threat of an initiative as a way to force action that otherwise might not occur.”
Getting lawmakers on the same page was no small feat. For months, the House and Senate were at odds over how to approach reforms, and Andes recalled then-House Speaker Sal DiMasi urging activists to take a harder line supporting his approach. DiMasi’s press secretary, she said, asked GBIO to hold a press conference outside then-Senate President Robert Travaglini’s office criticizing Travaglini’s position on the legislation as putting thousands of lives at risk.
Despite the heightened emotions, Democratic legislators did ultimately achieve compromise, and Republican Gov. Mitt Romney signed the bill into law on April 12, 2006, in a ceremony at Faneuil Hall. The measure would soon become the model for the federal Affordable Care Act.
The law, which combines new subsidies for lower-income residents with a mandate that all adults purchase coverage, has led Massachusetts to have the lowest rate of uninsured residents of any state, at 2 to 3 percent, as McDonough outlined in this recent essay for CommonWealth Beacon.
Andes said the history highlights the opportunity for change that comes when a major public policy issue erupts, someone has an idea, and those in power have “political will” to pursue a solution.
“When those three windows are open or held open long enough, you can drive big change,” she said.
On this episode, Andes recounts how GBIO got involved (8:45), McDonough discusses the role a ballot initiative played (13:30), and both describe the influence the law had on national policy and future campaigns (33:00).
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