Massachusetts Sets Health Plan for Nearly All

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April 5, 2006

Massachusetts Sets Health Plan for Nearly All

By PAM BELLUCK

 

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 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, 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. "

 

Katie Zezima contributed reporting for this article.