Massachusetts Begins Universal Health Care
By Christopher Lee
Washington Post Staff Writer
Sunday, July 1, 2007; A06

BOSTON -- There is a lot of talk about overhauling
health care in the United States, but Massachusetts is
actually trying to do it -- again.

Today, the home of some of the nation's most
prestigious hospitals and medical schools becomes the
first state to require its residents to have health
insurance or face financial penalties. Making
insurance mandatory -- and more affordable -- for
Massachusetts's 6.5 million residents is the
centerpiece of a law approved by the legislature last
year that civic and business leaders hope will
dramatically reduce the ranks of the state's 400,000
uninsured and the number of people who seek costly
"uncompensated" care in hospital emergency rooms.

This is not the first time the state has attempted to
tackle the problem. Nearly 20 years ago, then-Gov.
Michael S. Dukakis signed universal health-care
legislation that was supposed to bring coverage to
everyone by 1992. But the law's requirement that
employers provide coverage to workers or pay a tax
proved unpopular, and it was never implemented.

Still, Massachusetts's new grand experiment could
become a model for major changes in health care across
the country -- if it works.

Already Democratic presidential candidates are
borrowing some of its elements for their campaign
platforms, Gov. Arnold Schwarzenegger (R) is pushing a
similar plan in California, and other states are
watching closely.

President Bush signaled last week that state
experiments such as Massachusetts's will play a key
role in remaking a U.S. health-care system that he
described as too costly, too confusing and leaving too
many people uninsured.

"States should make reforms to ensure that their
citizens have access to basic private health
insurance," Bush said after meeting with health-care
experts at the White House. "If we want a better
system, the federal government has got a
responsibility to reform, and so do states. . . . The
choices we make now will set the direction of medical
care in America for years to come."

Their place in the national spotlight is not lost on
the Massachusetts officials, business leaders and
consumer advocates who forged an unlikely alliance to
get the law passed in April of last year. They know
that would-be reformers around the country are hoping
that they will succeed, and that skeptics were quick
to cluck over early reports this spring that the new
state-facilitated insurance plans might be
unaffordable for average residents.

"They might like to imitate us, some of them, but a
lot of them can't wait for us to fail," said Jon
Kingsdale, executive director of the Commonwealth
Health Insurance Connector Authority, the new state
entity implementing the law. "It's actually very
helpful pressure, because people in Massachusetts feel
the pressure of the national eyes on us, so they are
particularly concerned that this not fail. It actually
gives us more momentum."

Although July 1 marks the beginning of the "individual
mandate" -- the legal obligation to obtain health
insurance -- the real deadline is Dec. 31. When
Massachusetts residents file their state tax returns
next spring, they must certify that they had
acceptable coverage as of the end of 2007 -- or lose
the $219 personal exemption. The penalty grows steeper
in subsequent years, big enough, officials hope, to
persuade most holdouts to get coverage.

The state's 175,000 employers have to pitch in, too.
Businesses with 11 or more full-time employees that do
not offer health insurance must pay an annual "fair
share" assessment of $295 per employee. And businesses
must arrange to allow workers to pay health insurance
premiums with pre-tax dollars.

"We need to be fair and lenient in terms of
enforcement both on employers and individuals in the
first year in order to not incur some kind of a
backlash," said Richard C. Lord, president of
Associated Industries of Massachusetts and a member of
the Connector board. "We need to . . . give everybody
a chance to adjust to the new realities."

The government, for its part, is defining basic
coverage and trying to make insurance more affordable.
Under its new Commonwealth Care program, it is
subsidizing coverage with no annual deductible on a
sliding scale for people with incomes of up to 300
percent of the federal poverty level, or $61,950 for a
family of four. About 130,000 low-income people are
already enrolled either in Commonwealth Care or
MassHealth, the state's Medicaid program, state
figures show. The poorest pay no premiums.

Those who do not qualify for subsidies and cannot get
coverage through their jobs can buy low-cost but
unsubsidized health plans offered by private insurers
through the Connector under the Commonwealth Choice
program. Premiums go up with age, but people cannot be
charged more if they are sick or be denied coverage
because of a preexisting condition.

Costs are still too high for some. Already, state
officials expect to exempt 60,000 residents from the
new mandate because they cannot afford the insurance
at the going rates, even though they earn too much to
qualify for subsidies. That is a big reason that
Massachusetts is destined to fall short of universal
coverage under the new law, officials say, although
proponents say covering 99 percent of residents is
possible.

"Affordability is the big question here," said Kathy
Swartz, a professor at the Harvard School of Public
Health, who noted that even those with a basic plan
could face high deductibles. "It's certainly what a
lot of other states are wrestling with -- how do you
bring the costs down?"

The state's costs are a concern, as well, with some
analysts wondering whether Massachusetts will be able
to keep funding the $1.6 billion-a-year program if the
economy slumps or if costs rise substantially over the
next few years.

"This is not an enterprise for the faint of heart,"
said former Democratic state lawmaker John McDonough,
executive director of Health Care for All, a nonprofit
group that pushed for the new law. "There are always
risks. There are always problems. There are always
clouds on the horizon that could turn into a storm.
Get used to it."

About 57 percent of all Massachusetts residents say
they support making health insurance compulsory,
according to a poll released last week by the Kaiser
Family Foundation. But two-thirds of respondents said
they expect the new law to cause their taxes to
increase. And 72 percent said they did not know the
deadline for getting coverage. The plain fact is that
most residents will not be affected directly by the
new law because more than 90 percent already have
insurance, often through their jobs or, for the
elderly, through Medicare.

Charles Paine, 64, a cab driver from the Boston suburb
of Waltham, said he supports the law. Paine, who has
diabetes, already receives help from the state and
said he expects to enroll in one of the subsidized
plans.

"I'm one of the ones they call working poor," he said.
"I make enough to get by, but I don't have enough to
pay my bills and have health insurance. I think it's
ludicrous not to have health insurance for everyone. I
don't think you should work your whole life, and get
sick, and lose everything you've worked for. It will
be tight for me, but I've got to have it."



________________________________________________________________________________\
____
Got a little couch potato?
Check out fun summer activities for kids.
http://search.yahoo.com/search?fr=oni_on_mail&p=summer+activities+for+kids&cs=bz