Breaking News: Massachusetts Speaker Reverses Self, Backs Casino Vote

The Massachusetts state House Speaker Salvatore DiMasi, an opponent of gambling, has resisted efforts by Gov. Deval Patrick to ask voters to legalize casino gambling in the Bay State. But DiMasi appears to have relented, saying he would support referring an advisory question to voters this November. DiMasi is bowing to public and legislative support for Patrick's plan, and to his own political weakness, according to the Boston Globe.

IN THE STATES: Creating Incentives for Primary Care Physicians in Massachusetts

Since 2006 more than 340,00 previously uninsured residents of Massachusetts have gained health insurance. As The New York Times recently noted, the expansion in coverage stretched the state's health care resources, especially in primary care. That's why we were particularly encouraged to read Elizabeth Cooney's Boston Globe piece on how community health clinics in Massachusetts have successfully recruited much-needed primary care physicians through a loan repayment program.

Funded by a $5 million grant from the Bank of America and administered by the Massachusetts League of Community Health Centers, the program provides up $25,000 a year for three years to repay loans. In its first year the program recruited 47 clinicians—more than double what they expected. Before the incentives, these centers last year had been unable to fill about 10 percent of their primary care positions.

COVERAGE: The Big Picture in the Bay State

"Who said it would be easy?" That headline on the Boston Globe's editorial about the Massachusetts health care for all initiative is as wise as it is simple. We often mutter something similar ourselves when we look ahead to the enormous task of fixing the whole country's health care: "If it were easy, we'd have done it already."

We have naturally watched with interest as Massachusetts lawmakers and officials work to close the fiscal gaps (estimated at about $100 million) and develop accurate assessments of future demand as they strive to make sure that everyone in the state has health insurance. The Globe didn't hone in on the financial details today, focusing on the big picture. Although Massachusetts had a relatively low uninsured rate before the reform bill was enacted two years ago this week, it is a high-cost state and enrollment in subsidized insurance plans has been much higher than expected. And it is nearly impossible for a state to fix all the problems on their own, particularly how we pay for and deliver health care, without a systemic nationwide approach. (Hear that Washington?)

TUESDAY ROUND UP: Colorado Corporate Crooks, and Suicide on the Street

NYT MISSES THE POINT IN COLORADO: The New York Times weighs in on the Colorado ballot initiative that would make corporate executives criminally responsible if their companies break the law. The Times focuses on the angry Qwest employees who are backing the measure, and misses the larger context. The initiative is part of a union-business battle that encompasses other measures in the state. The center of the fight is a right-to-work initiative, which has been countered by five recent initiatives filed by the United Food and Commercial Workers, best known for representing the people working in grocery stores.

RIGHT TO DIE ON THE STREET: Well, not yet. But the attacks have begun on the latest assisted suicide initiative from ex-Governor Booth Gardner. Petition gatherers, many from California, are already on the street gathering signatures. Anyone out there know the price?

DOG DEBATE: A debate breaks out over how many workers might be affected if a dog-track measure doesn't pass in Massachusetts.

Department of Threats: The Latest

Interest groups and politicians often get what they want simply by threatening an initiative or referendum. They never bother to go through with the campaign.

In Massachusetts, a supporter of Gov. Deval Patrick's plan to license three casinos in the state is threatening to take the idea to the people if it fails to get through the legislature. Massachusetts has the referendum and the initiative, but the power is weak in the state constitution. Such a vote might likely be advisory.

St. Patrick's Day Round Up

Lots of items this morning

INITIATIVE SPONSOR TO GAYS: 'JUST SHUT UP': One of the two Oregon legislators sponsoring a ballot initiative that would allows employers to discriminate on the basis of sexual orientation shares "my advice to the gay community". That advice? "Shut up, just don't talk about it." He nows says that he was sharing advice he used at his own business, which produces hazelnuts.

RIGHT TO WORK EQUALS NIXON: An interesting Huffington Post item recalls then Vice President Nixon's backing of ballot initiatives to establish "right to work" laws, overturning "closed shop" rules that required workers to join unions as a condition of employment. A battle is brewing now in Colorado over a similar measure. (Click read more to see more items)

BUT YOU CAN STILL GET A GOOD STEAK THERE: Kansas City votes April 8 on a local ballot initiative that will strengthen its relatively weak anti-smoking law. The city council there is trying to beat the initiative by adding its own tweaks to the law.

IN THE STATES: Massachusetts Looks to Address the Linked Problems of Cost and Coverage

Two years ago, Massachusetts produced an impressive example of bi-partisan health reform when a Republican governor, Mitt Romney, agreed to cover all citizens and a Democratic legislature agreed to operate within a private market system. This week, that conversation continued, as leaders in Massachusetts examined different ways of controlling costs and changing the state's payment system. The goal is to make the state's commitment to coverage a sustainable reality.

Speaking before the joint Committee on Health Care Financing, Senate President Therese Murray outlined the major points of proposed legislation to control costs, noting that health care spending had grown 33 percent between 2002 and 2006, to $62.1 billion, Murray concluded "We cannot afford to stand by and let this continue."