Today we begin a series of occasional posts that bring Campaign Desk readers up-to-date on the workings of Massachusetts health reform and how the press is reporting on them.

A few years ago, Bay State lawmakers, with the blessing of Gov. Deval Patrick,
tossed some 30,000 legal immigrants off of the state’s health insurance plan, barring them from receiving subsidies for coverage through Commonwealth Care, Massachusetts’s shopping service for those needing financial help to buy coverage. The state ran into a budget problem and had to trim the cost of its health program, which—as even those who designed the law admit—offers little in the way of cost containment. With untamed medical costs pinching, something needed to go.

Earlier this month, the state’s Supreme Judicial Court ruled that it was unconstitutional for Massachusetts to deny these immigrants health insurance subsidies. Said the court: “The discrimination that its limiting language embodies violates their rights to equal protection under the Massachusetts constitution.” That means in the next few months the state must find a way to cover the cost of subsides for these immigrants. Jay Gonzalez, the State Secretary of Administration and Finance, predicted the court’s ruling would have a significant impact, with the costs of subsidies adding “somewhere in the range of $150 million in annual costs to what is already a very challenging budget.” WBUR’s Martha Bebinger reported the state could consider new taxes or fees to help pay for immigrant coverage; it could cut other programs, or make subsidized coverage less generous for everyone.

You would think that would have been big news for the national press following ex-governor Mitt Romney, under whose administration the reform law was crafted. But it wasn’t. Yet the options Bebinger laid out have implications for the success of national health reform, should it move forward after the U.S. Supreme Court rules next June. Is a law without effective ways to control medical costs patterned after the Massachusetts model, also without strong cost containment measurers, likely to meet the same fate? That is, will the federal law promise groups of people insurance subsidies, only to drop them when the budget gets tight, and later scramble to find funds for those subsidies after a court says no dice? Shouldn’t the press have asked Romney about this?

Even Bloomberg columnist Michael Kinsley, who dissected Romney’s health care message at the end of last week, didn’t mention the immigrant ruling, which is a consequence of the state’s failure to control costs. Kinsley noted that shortcoming of Romney’s reform to contain medical inflation, but instead asked the question more broadly. Romney has said he regards the medical inflation dilemma as a national problem and will deal with it nationally when he becomes president. Kinsley asks: “How does he decide what is a national problem, on which the president must act, and what is a state problem, to which there might be 50 appropriate solutions?”

The Boston media, along with the AP and The New York Times covered the court’s ruling as a straight bread-and-butter news story with implications for the state. But they chose to portray the numbers of immigrants affected differently, offering another lesson in journalistic pick-and-choose. Bebinger reported that the decision “affects roughly 40,000 residents.” The Boston Globe said it “could affect up to 37,400 immigrants who have had legal status for less than five years.” The Times noted that the 2009 state budget “dropped about 29,000 legal immigrants,” while the AP reported “Massachusetts cannot prevents tens of thousands of legal immigrants from enrolling in Commonwealth Care.”

Dick Powers, the spokesman for the Massachusetts Connector, told me that some 30,000 legal immigrants lost their coverage when the state ran into money trouble. It established a special insurance program for them and 13,400 people took advantage of it while 24,000 new legal immigrants are on a waiting list. The numbers add up to another story for another day.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.