by Daniel C. Vock
Massachusetts has accomplished the improbable: It got Democrats and Republicans to agree on how to provide nearly every resident with health insurance. And it did so without boosting taxes or pushing aside private health plans.
Spearheaded by outgoing Gov. Mitt Romney (R), the compromise marks a marriage of competing visions for health care reform shaping state policies around the nation. Democrats stress the need to move toward health coverage for all. Republicans promote putting consumers in control. What Massachusetts did was to fuse these philosophies.
While Massachusetts is hailed as a trailblazer, even states with less ambitious goals are setting out to repair the country’s broken health care system. The changes go beyond taxpayer-funded Medicaid programs for the poor and disabled. States are expanding medical coverage for the working uninsured, rewarding patients who develop healthy habits and prodding private industry to offer greater health benefits.
States feel the brunt of spiraling medical costs in their bottom line. Plus, there’s powerful political pressure for states to address the problem of the uninsured. The Census Bureau found that nearly 47 million Americans – one in six – went without health insurance in 2005. When it began keeping track in 1987, 31 million Americans – fewer than one in eight – lacked coverage.
Massachusetts’ new policy aims to cover 460,000 uninsured residents by July. Some 106,000 are already eligible for Medicaid care but weren’t enrolled. Another 150,000 will get help buying a private health insurance policy, subsidized by a portion of the $1 billion the state now uses to reimburse hospitals for charity care.
The remaining 204,000 must buy private insurance through their employers or through a new state agency. That group includes many uninsured workers who consider private coverage too expensive or who are young, healthy and willing to risk going without. They will face tax penalties if they don’t buy a policy: loss of their personal exemption, and by 2008, a penalty equal to half of what health insurance premiums would have cost. Employers who don’t provide health insurance will face annual penalties, too – $295 per worker.
“I think one of the things that came out of Massachusetts, which is in the air in many state capitols and hopefully here in Washington (D.C.), is the incredible sense of compromise that they were able to pull off,” said Alice Burton, director of the Robert Wood Johnson Foundation’s State Coverage Initiatives.
The task of covering the uninsured is easier in Massachusetts than in most other states. Its 10.7 percent uninsured rate already is one of the lowest in the country. But other states are trying to close the uninsured gap, too. Soon after Massachusetts adopted its plan, Vermont’s Republican Gov. Jim Douglas and the Democratic majority in the Legislature took similar action.
The Vermont approach shares many elements with Massachusetts’ reforms: premium assistance for the working uninsured, enhanced Medicaid benefits and an opportunity for all residents to buy insurance through the state, at premiums ranging from $60 to $135 a month. It also penalizes businesses that don’t offer health insurance.
Expanding health care coverage is a big issue in many other state capitols as well.
