After four rocky weeks while his landmark health insurance law has been disparaged as poorly managed, expensive and disappointing, President Barack Obama will travel to Boston on Wednesday to try to reset expectations about Obamacare.
Obama is scheduled to deliver a speech in 271-year-old Faneuil Hall, where some of the seeds of the American revolution took root - and where on April 12, 2006, the start of another historic shift began.
Against the backdrop of a huge painting of a famous debate on preserving the union at a time when the nation verged on civil war, then-Republican Governor Mitt Romney signed a law mandating health insurance for most of the state's residents.
Democratic Senator Edward Kennedy, who had long advocated for health reform, stood behind Romney's chair on the ornate dias, looking victorious, as state Democrats crowded around.
On Wednesday, Obama will try to channel that moment and draw lessons from the Massachusetts experience to argue that Obamacare - his version of health insurance reform - will improve people's lives and help the country's economy, even if the online registration process has gotten off to a slow and troubled start.
Obama used the Massachusetts plan as a blueprint for his healthcare exchanges, which went live on Oct. 1, and require Americans to buy insurance by March 31.
Republicans have fought a bitter war to try to defund or delay the law, and have reveled in the disastrous roll out of a website beset by bugs that will take until the end of November to fix - and in complaints from consumers who have found their health care insurance plans are changing.
They have found a new attack point in Obama's pledge that Americans who like their health plans can keep them under Obamacare. In recent days, reports have piled up about thousands of people being kicked off their current, lower-cost plans because those plans no longer comply with the minimum benefits required by the new law. [ID: nL1N0IJ26C]
And while Obama will point to hiccups in the rollout of "Romneycare" as he tries to ease pressure on his own signature health overhaul, a direct correlation would be a stretch.
'EVERYTHING IS BROKEN DOWN'
Romneycare is smaller - given the size of the state - and far less complex than Obamacare, said several veterans of the state-run system.
But the biggest difference between the two is the bitter political environment in which the fledgling Obamacare program is operating.
It was only seven years ago that Robert Travaglini, then president of the Massachusetts senate, stood beside Kennedy as Romney signed the bill. But it seems as thought it were a long-ago political era, Travaglini told Reuters.
"The whole spirit, the whole chemistry, was one of cooperation" at the time, Travaglini said in an interview.
"We had two major power players both working for the same goal. You don't have that here! Everything is broken down," he said.
The day after the law was signed, its backers met on the 11th floor of the Prudential Tower downtown, in the offices of Partners Health Care, a hospital system, and formed a coalition to bolster support across the state, said John McDonough, then a consumer advocate with Health Care for All.
There was some apprehension that the project could fail, said McDonough, now with Harvard's Department of Health Policy and Management.
"It felt like we were on the verge of trying something very significant and very large," he said, recalling Boston Globe articles comparing the program to the "Big Dig," a highway project from the 1980s famous for its huge cost overruns.
The law was set to take effect in October. But the state agency running the program delayed some parts by a few months, needing more time to build a system to bill and collect premiums, said Jon Kingsdale, its first executive director.
It got a jump start by automatically enrolling about 50,000 uninsured people who had been treated at hospitals in the state, and were in a database - something that does not exist for Obamacare.
The agency spent less than $1 million on the website used by consumers to shop for insurance. It had a much simpler "back end," in part because it did not need to verify identities.
"It was a small build compared to any under the Affordable Care Act," Kingsdale told reporters on a conference call.
Consumers had a year to get insurance or face penalties - a much longer deadline than under Obamacare, which has a final deadline of March 31.
According to the most recent data from the Massachusetts Center for Health Information and Analysis, about 20 percent of the 5.5 million insured people in the state got their insurance individually on the open market or through one of the publicly subsidized programs under Romneycare.
Polls consistently show about two-thirds of the state's residents like the program, said Jonathan Gruber, an economist at the Massachusetts Institute of Technology.
Alessandro Bellino, 29, who runs a coffee cart in Boston's Financial District, said he shopped for health insurance in 2010 using the Massachusetts Health Connector online marketplace immediately after graduating from Berklee College of Music.
"I typed in my age and stuff like that, and it came up with a bunch of prices for different companies and plans," he recalled.
"I just chose the cheapest one. It seemed fine to me. There were no problems," he said. "It was painless."
But when the exchange opened for business early in 2007, only 123 people signed up for insurance the first month. Most people - particularly healthy people - waited until the end of the year, said MIT's Gruber, who worked on both Romneycare and Obamacare.
"Insurance is a tough sale. Nobody goes down to their broker on a Saturday morning to smell the leather and test drive this baby," said Kingsdale, now a director with Wakely Consulting Group.
"It's a grudge buy. So there's going to be a lot of browsing," he said.