[Dialogue] Universal HealthCare in Massachusetts

Wed Apr 5 05:46:59 EDT 2006

It's about time -- and by a Republican Governor to boot!
Cynthia

BOSTON, April 4 — Massachusetts is poised to become the first state to  
provide nearly universal health care coverage with a bill passed  overwhelmingly by 
the legislature Tuesday that Gov. _Mitt  Romney_ 
(http://topics.nytimes.com/top/reference/timestopics/people/r/mitt_romney/index.html?inline=nyt-per)  says 
he will sign. 
The bill does what health experts say no other state has been able to do:  
provide a mechanism for all of its citizens to obtain health insurance. It  
accomplishes that in a way that experts say combines methods and proposals  from 
across the political spectrum, apportioning the cost among businesses,  
individuals and the government. 
"This is probably about as close as you can get to universal," said Paul B.  
Ginsburg, president of the nonpartisan Center for Studying Health System  
Change in Washington. "It's definitely going to be inspiring to other states  
about how there was this compromise. They found a way to get to a major  expansion 
of coverage that people could agree on. For a conservative  Republican, this 
is individual responsibility. For a Democrat, this is  government helping 
those that need help." 
The bill, the product of months of wrangling between legislators and the  
governor, requires all Massachusetts residents to obtain health coverage by  July 
1, 2007. 
Individuals who can afford private insurance will be penalized on their  
state income taxes if they do not purchase it. Government subsidies to private  
insurance plans will allow more of the working poor to buy insurance and will  
expand the number of children who are eligible for free coverage. Businesses  
with more than 10 workers that do not provide insurance will be assessed up to  
$295 per employee per year. 
All told, the plan is expected to cover 515,000 uninsured people within  
three years, about 95 percent of the state's uninsured population, legislators  
said, leaving less than 1 percent of the population unprotected. 
"It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal  
plan," said Stuart H. Altman, a professor of health policy at Brandeis  University. 
"It isn't that at all. It is a pretty moderate approach, and  that's what's 
impressive about it. It tried to borrow and blend a lot of  different pieces." 
Many states, including Massachusetts, have been wrestling for years with  how 
to cover the uninsured, and several states have come close, according to  the 
National Conference of State Legislatures. Hawaii passed a universal  access 
law in 1974 requiring employers to offer health care coverage for  employees 
working 20 hours or more a week, but nearly 10 percent of people  remain 
uncovered. Efforts to cover all citizens in Minnesota and Vermont in  1992 and in 
Massachusetts in 1988 fell flat in the mid-1990s when the language  in the bills 
concerning universal coverage was repealed. 
In 2003, Maine enacted a law that significantly broadened insurance  coverage 
and combined employer payments with expanded government programs.  That year, 
California enacted a law that required employer contributions, but  it was 
repealed in a referendum in 2004. Massachusetts would be the first  state to 
require its citizens to have health insurance. 
The Massachusetts bill creates a sliding scale of affordability ranging  from 
people who can afford insurance outright to those who cannot afford it at  
all. About 215,000 people will be covered by allowing individuals and  
businesses with 50 or fewer employees to buy insurance with pretax dollars,  and by 
giving insurance companies incentives to offer stripped-down plans at  lower 
cost. Lower-cost basic plans will be available to people ages 19 to  26. 
Subsidies for other private plans will be available for people with incomes  
at or below 300 percent of the poverty level. Children in those families will  
be eligible for free coverage through Medicaid, an expansion of the current  
system.  
The Massachusetts bill was hammered out with proposals and input from state  
Democratic legislators; Mr. Romney, a Republican; Senator _Edward  M. Kennedy_ 
(http://topics.nytimes.com/top/reference/timestopics/people/k/edward_m_kennedy
/index.html?inline=nyt-per) , a Democrat; insurers; academics; businesses; 
hospitals; and  advocates for the poor, including religious leaders. 
They were motivated in part by a threat by the federal government to  
eliminate $385 million in federal Medicaid money unless the state reduced the  number 
of uninsured people. The state was supposed to have the bill completed  by 
January, but state officials said they were confident that the federal  
government would approve of Tuesday's bill.  
"Whenever you can have the medical community, the business community and  the 
advocates all applauding our efforts, I think that's indicative of a  
successful exercise," said State Senator Robert E. Travaglini, the majority  leader.  
Mr. Romney, who is considering running for president in 2008, said in an  
interview Tuesday that the bill, passed by a legislature that is 85 percent  
Democratic, was "95 percent of what I proposed." 
He said, "This is really a landmark for our state because this proves at  
this stage that we can get health insurance for all our citizens without  raising 
taxes and without a government takeover. The old single-payer canard  is 
gone." 
Mr. Romney pushed the idea of the "individual mandate," requiring people  who 
can afford insurance to buy it. The bill makes it possible for employers  to 
enable many of those people to use pretax dollars, saving them 25 percent  or 
more. Individuals who fail to get health insurance by July 2007 will first  
lose their personal exemption on their state taxes. In subsequent years, they  
would have to pay a penalty that could be as high as half of what an  
affordable health care premium would cost.  
Eric Fehrnstrom, the governor's communications director, said that for  those 
people with incomes above 300 percent of poverty, "our assumption was  that 
these would be mostly single mothers who just did not have the  wherewithal to 
get insurance. It turned out it was mostly young males. In some  cases they 
are making very attractive salaries. These are people who just  don't imagine 
themselves needing care, but of course when they break a leg  when they're out 
bungee jumping they go to the hospital and we end up paying  for their care 
anyway." 
One element that Mr. Romney and some legislators did not want was the fee  
for employers who do not provide health insurance.  
For several months the bill seemed stalled because the House and Senate  
leaders could not agree on the issue of charging businesses. One proposal of  an 
$800-per-employee charge was reduced to a maximum of $295 that would go  toward 
paying costs for the uninsured and would be reduced as more people  became 
insured, Mr. Travaglini said. 
Because the bill is part of a budget bill, Mr. Romney has line-item veto  
power. He said Tuesday that he would likely change the business fee provision  in 
some way or veto it before signing the bill. 
Still, he did not seem that worried about it, saying he had been most  
concerned that the fee not be a payroll tax, as had been originally proposed.  Mr. 
Travaglini said that if Mr. Romney vetoed the business fee, the  legislature 
would override it. 
Bob Baker, president of the Smaller Business Association of New England,  
said his members seemed to accept the idea of the fee. 
"The notion of the level playing field, I think from an element of fairness  
and equity, people are O.K. with it, unless it impinges on their ability to  
pay for it," Mr. Baker said. "There hasn't been a hue and cry among our  
members." 
Mr. Romney said that with more people insured, everyone would "get better  
health care" and that premiums for people who already had insurance might drop  
because "providers won't be pushing the cost of the uninsured onto the people  
who have insurance." 
James Roosevelt Jr., president and chief executive of Tufts Health Plan,  
agreed. 
"I think that will help both improve the quality of health care and lower  
the cost," Mr. Roosevelt said, but he added, "We would have liked more  
flexibility in the design of health plans to permit lower premiums that are  
affordable for all people." 
The program, which was approved 154 to 2 in the House and 37 to 0 in the  
Senate, will cost $1.2 billion over three years, but only $125 million of that  
will be new state money. The rest will come from federal money and existing  
state money. After three years, lawmakers say, no new state money will be  
required. A new agency will administer the system. 
Advocates for the uninsured held a victory rally at the Statehouse. 
"We're thrilled that this truly represents a commitment to the poor and the  
working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston  
Interfaith Organization.  
Joseph Landais, 64, could use insurance for himself, his wife and three  
children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's  
aide, makes too much for the family to be eligible for Medicaid but not enough  
to afford insurance. He had a hernia operation four months ago that he did not  
have to pay for under the free-care pool, but he had not been able to see a  
doctor since then, even though he is still not feeling well. 
"After years that you've been working that hard," Mr. Landais said, "I  think 
you deserve something back."

Cynthia N.  Vance
Strategics International Inc.
8245 SW 116 Terrace
Miami,  Florida, 33156
305-378-1327; fax  305-378-9178
http://members.aol.com/facilitationfla

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Cynthia N.  Vance
Strategics International Inc.
8245 SW 116 Terrace
Miami, Florida,  33156
305-378-1327; fax  305-378-9178
http://members.aol.com/facilitationfla
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