Mass. Enacts Universal Health Care Plan

<div class='quotetop'>QUOTE(ghostofjk @ Apr 5 2006, 06:53 AM) [snapback]235194[/snapback]</div>

I need to move to massachusetts and move out of Ohio...

 

Here is the article:

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."

"The old single-payer canard is gone"

That's too bad. I think the Canadian single payer universal system is the best way to go. Everyone is covered in Canada; no one ever gets a medical bill. Not only that, but businesses can be more competetive because they are not responsible for health care for their workers - the government is responsible for all citizens. Even the unemployed are covered. Car makers, for example, would rather located in Ontario than in the US because they have no health care obligations. Better for ordinary people and better for business. What's not to like about the Canadian system? True, they have to address the issue of delays, but that can be fixed with a little more money, still far less per capita than the US system.

 

Think the Canadian system is good? Check out the patients in hospitals in Buffalo, NY and other border cities... lots of Canadians there, paying CASH, to get medical care that they are wait-listed for in Canada.

Bottom line: There is no "free lunch".

 

<div class='quotetop'>QUOTE(bgdrewsif @ Apr 5 2006, 06:56 AM) [snapback]235195[/snapback]</div>

And I thought it was because I was in Ohio :lol: :lol: :lol:

Actually, I am keeping on eye on this, it has promise. However, i predict the most trouble will come from the "no solution is good unless it is a perfect solution" crowd.

 

Hey, if it can get more people from going to the emergency room when they really don't have to, it will just about pay for itself.

 

<div class='quotetop'>QUOTE(ghostofjk @ Apr 28 2006, 02:56 AM) [snapback]246525[/snapback]</div>

I am sorry, you must be reading the "before the new bill" part of the story. The logic of the bill is that if more people have access to primary care (regular physician) on a ongoing basis, they can in many situations avoid ever getting so sick that they need to go to the ER.

And then there are the folks who use the ER as if it were their regular physician's office... well, since they will be paying for and have insurance in the first place, they will be more motivated to seek care from a physician, since a physician's office is a much more pleasant, efficient, etc. place to seek can than an ER, where if you're not an emergency case, triage keeps the "colds and sniffles" crowd waiting and waiting. (As it must be, so that the desperately ill, wounded, etc. can get care quickly.)

The other pillar of logic is, a fundamental insurance principle. If everyone is insured, then insurance costs wil go down for everyone in the group, since the costs of the insured event (sickness) are now spread over a larger group of people who are collectively sharing the risk. AND... costs will go down because "freeloaders" who can well afford insurance, won't be abusing the free care pool, which all of us who are insured have to pay for in our insurance rates as a consequence. In other words, now everyone who swims in the pool, will contribute to it's operation, and thus the costs will be more equitably spread to everyone, resulting in lower costs. (And that's even BEFORE you consider the savings realized by people using primary/preventive care through an ongoing relationship with a physician instead of episodic ER visits at hundred$ per visit.)

The MA bill is a terrific thing. It's going to take the people of MA who currently abuse ERs and the free care pool time to understand how much better things will be for them if/when they use the appropriate health care resources (physicians for preventive and ongoing care, ERs for emergencies). You watch, in 5 years things will be very good here in MA.

To our friend in Ohio -- come on east to MA! The winters certainly can't be any worse than Ohio, and you will be a lot closer to Cape Cod! And the rocky shores of Maine, and vineyards of Rhode Island, ski slopes of New Hampshire and Vermont, and the peaceful Connecticut hills. All within two hours or less, depending on where you are in MA.

And I can't resist adding -- and no matter who you love, you can get married here in MA too. But that's a different thread...

 

<div class='quotetop'>QUOTE(bacinmass @ Apr 28 2006, 09:23 AM) [snapback]246579[/snapback]</div>

you're instilling a bit envy in me about the Commonwealth :lol:

btw, why is MASS a 'Commonweath' state? Are there any more in the Union described as such?

just curious?

 

<div class='quotetop'>QUOTE(dsunman @ Apr 28 2006, 09:33 AM) [snapback]246587[/snapback]</div>

Yes, there is another Commonwealth in the US, and the is the Commonwealth of Virginia. I think the Commonwealth versus "state" has something to do with when the state was formed, in it's constitution and other original principles when the state was established.

Can any historians help us here?

Oh, and by the way, Massachusetts used to be much larger -- the current state of Maine used to part of Massachusetts. (Until 1810, I think... where's a historian when you need one?)

Welcome to Massachusetts!


<div class='quotetop'>QUOTE(bacinmass @ Apr 28 2006, 09:39 AM) [snapback]246591[/snapback]</div>

Whoops -- "the" = "that". Haven't had my coffee yet.

 

<div class='quotetop'>QUOTE(Danny @ Apr 28 2006, 06:49 AM) [snapback]246597[/snapback]</div>

Hate to dis Mitt but isn't this the plan that also fines the person, much like auto insurance, if they don't carry health insurance? Kind of a sweet deal proclaim universal health care by mandating fines if people don't have health insurance. Could be wrong I get my news from those liberal biased media outlets. <_< :huh:

Wildkow

p.s. I guess this is just another case of politicians being politicians.

 

I actually like the premise - I think that any solution that leans towards requiring/facilitating everyone having insurance is at least a step in the right direction.

Also, for what it's worth, I got very ill in Sri Lanka last summer, and had to visit a hospital there. I saw two doctors and countless nurses, was issued a boatload of medicine, and was charged something like $8 - the nurses explained to my husband that the charge was 'very high' because I wasn't a citizen, and it was only partially subsidized. I was impressed with both the level of care and the efficiency of the whole system, and I would like to see a lot of the waste in our system eliminated. If moving towards socialized healthcare brings up the quality and value of our healthcare system, I'm all for it