Mass. Lawmakers OK Mandatory Health Bill

By STEVE LeBLANC, Associated Press Writer 21 minutes ago

BOSTON - Lawmakers overwhelmingly approved a bill Tuesday that would make Massachusetts the first state to require that all its citizens have some form of health insurance.
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The plan — approved just 24 hours after the final details were released — would use a combination of financial incentives and penalties to dramatically expand access to health care over the next three years and extend coverage to the state's estimated 500,000 uninsured.

If all goes as planned, poor people will be offered free or heavily subsidized coverage; those who can afford insurance but refuse to get it will face increasing tax penalties until they obtain coverage; and those already insured will see a modest drop in their premiums.

The measure does not call for new taxes but would require businesses that do not offer insurance to pay a $295 annual fee per employee.

The cost was put at $316 million in the first year, and more than a $1 billion by the third year, with much of that money coming from federal reimbursements and existing state spending, officials said.

The House approved the bill on a 154-2 vote. The Senate endorsed it 37-0.

A final procedural vote is needed in both chambers of the Democratic-controlled legislature before the bill can head to the desk of Gov. Mitt Romney, a potential Republican candidate for president in 2008.

Romney has expressed support for the measure but has not said whether he will sign it.

"It's only fitting that Massachusetts would set forward and produce the most comprehensive, all-encompassing health care reform bill in the country," said House Speaker Salvatore DiMasi, a Democrat. "Do we know whether this is perfect or not? No, because it's never been done before."

The only other state to come close to the Massachusetts plan is Maine, which passed a law in 2003 to dramatically expand health care. That plan relies largely on voluntary compliance.

"What Massachusetts is doing, who they are covering, how they're crafting it, especially the individual requirement, that's all unique," said Laura Tobler, a health policy analyst for the National Conference of State Legislatures.

The plan hinges in part on two key sections: the $295-per-employee business assessment and a so-called "individual mandate," requiring every citizen who can afford it to obtain health insurance or face increasing tax penalties.

Liberals typically support employer mandates, while conservatives generally back individual responsibility.

"The novelty of what's happened in this building is that instead of saying, `Let's do neither,' leaders are saying, `Let's do both,'" said John McDonough of Health Care for All. "This will have a ripple effect across the country."

The state's poorest — single adults making $9,500 or less a year — will have access to health coverage with no premiums or deductibles.

Those living at up to 300 percent of the federal poverty level, or about $48,000 for a family of three, will be able to get health coverage on a sliding scale, also with no deductibles.

The vast majority of Massachusetts residents who are already insured could see a modest easing of their premiums.

Individuals deemed able but unwilling to purchase health care could face fines of more than $1,000 a year by the state if they don't get insurance.

Romney pushed vigorously for the individual mandate and called the legislation "something historic, truly landmark, a once-in-a-generation opportunity."

One goal of the bill is to protect $385 million pledged by the federal government over each of the next two years if the state can show it is on a path to reducing its number of uninsured.

The U.S. Department of Health and Human Services has threatened to withhold the money if the state does not have a plan up and running by July 1.

Um, yikes.

I have a few problems with this. While I think you're absolutely stupid not to have some form of health insurance, I don't like the idea of FORCING people to have health insurance.

Also, what's to stop poor people from flocking to Massachusetts to qualify for health coverage with no premiums or deductibles? That was a big reason why a universial health plan initiative crashed and burned in Oregon a few years ago.

This should open a can of worms.

I'm suprised it hurt that much. It ain't cheap to move. I don't consider myself poor by any means, and when we moved to NC, my wife already had a job, ... moving expenses, apartment deposit, first month's rent, and fees for driver's licenses, plates, etc still slammed our savings pretty hard.

What's in place to guarentee that the state provided health plan will actually pay the doctors? More and more doctors refuse to accept medicaid/medicare (my doctor has a sign on the front door of his office stating this) because the reimbursement rate is like $0.17 on $1.00. I bet doctors will run to the surround states a few years after this las goes into effect.

Who knows. But at least they're trying something to address this problem.

Come investigate a fraud case with me where a doctor denies state mandated vaccines to his patients so he can space them out and make money off of the administration fees and office fees ... THEN pity the poor, overworked doctor.

I agree that it ain't cheap to move, but if you badly need medical treatment to have a decent life, you might be compelled to do whatever you can to achieve that.

Can't say that all doctors are innocent... but maybe if insurance compensation rates were higher they wouldn't cheat patients like that.

One of the biggest problems I have with this is:





How is one "deemed" able to purchase health care? How do they know what citizen X can and cannot afford? What factors do they consider? Children? College-aged children? Other debts? Mortgages? Other family members who are cared for by citizen X? Job safety?

This goes back to my fundamental problem with those that say so and so makes X amount of money and, therefore, should pay X amount in taxes because they can afford it. Who and how are we to make that judgment?

I'm skeptical that people will move to a state just for the health insurance. Maybe it'll be a factor, but I would doubt it would be anything resembling a flock.

Second, the govt compels people to do things all the time for their own good. Now, you can argue that they shouldnt be allowed to do this at all, but this really isnt out of line with other things the law requires, as far as i can tell.

Then you're going to just kick up insurance premiums. I'd look at pharmaceutical costs. Everytime a new vaccine comes out, it costs more than all the previous vaccines put together. NC used to supply all the vaccines for all children, now for half the vaccines that are recommended kids in NC can't get it if insurance won't cover it, and what are the chances an insurance company's gonna cover it if NC doesn't require it?

You certainly have more experience in this area than I, so I can't really debate you on that.

I still think it has to do with Medicare repayment rates. If doctors won't accept Medicare because payment rates are so low they have to rely on private insurance to collect from patients or risk getting nothing but the co-pay. Private insurance companies know they have doctors by the short hairs because of this and are taking advantage of the situation. So you can accurately say that insruance companies are f**king the doctors over, but I would add that they are just following teh governments lead and this bill will cement this problem into law.

Isn't there already a federal law stating that if you have over X amount of employees (I think it's 50, but don't quote me on this) then you have to offer insurance?

I think this bill is ridiculous. What's to stop an employer from offering health insurance with the employee paying 95% of the premium? Then, if the employee can't afford it, they get fined?

Absurd. I need to look for a new job now. That $295 a year from the employers isn't going to cover the cost of this, so I'm sure my income taxes in MA are about to go up

I can't imagine no one has proposed an equation for these kind of questions. It's not going to be a straight dollar amount, is it?

I don't know about you guys, but I'm all for this proposal.

The current system covers only the uninsured who make under 2 times the federal poverty level, as well the chronically unemployed who make less than 1.33 of the same level. Not only that, those without insurance cost Mass taxpayers nearly $1 billion yearly since the government is forced to pay for their treatments through the UCP.
$1 billion is spent on the Uncompensated Care Pool, which covers those who aren't covered. The House propsal will cover everyone, and also save the UCP big time. I mean, the UCP savings would make up for the MassHealth funding.

-Sunny

It's not quite that simple. As supply of healthcare increases (it becomes state funded) demand will increase too. Econ 101. Any cost estiamtes for a program like this should be doubled at mininum.

I don't know how else they could do it. Otherwise, the Bill would have so many permutations and exceptions that, as a practical effect, applying it across the board would be impossible and would essentially gut that requirement.

What bill doesn't have hundreds of permutations and exceptions? I'm one of 6 people in NC who dedicate half their jobs to explaining the immunization law to people.

A child can have a free vaccine from the state if you're underinsured or insured, unless you want pneumococcal, meningococcal, pertussis, or rotavirus. If a child is uninsured, Native American, Native Alaskan, or on Medicaid, they can have a free vaccine from the state. If you're underinsured and you want pneumococcal, meningococcal, pertussis, or rotavirus, you must locate a designated Rural Health Center or Federally Qualified Health Center.

By the age of two every child ... blah, blah, blah ... unless blah, blah, blah.
By the start of kindergaten every child ... blah, blah, blah, ... unless blah, blah, blah ...

If you are religiously opposed to vaccination, you must write a letter in good faith stating a bona fide religious exemption, if said letter states a philosophical exemption and not a religious exemption ... it must be redrafted. Medical exemptions must be approved by the state and issued to the health director of the county health department in the county in which the student resides. Religious exemptions cannot be issued for one child and not another. One can be religiously exempt to hepatitis B, based on blah, blah, blah, but not MMR based on blah, blah, blah ...

Christ, it goes on for pages and pages.

Just because it would be complex, doesn't mean they couldn't do it if they wanted to do it right (or semi-right).

I think you're missing my point. Allowing exceptions for the requirement that you need insurance based upon certain, defined parameters is one thing. Basing them on circumstances similar to how the IRS allows credits and deductions is another. That's essentially what it will come down to.

Hey man, take a look at this case study one of the groups did for my Senior Economics Seminar class. It analysis various proposals for healthcare reform. It's well written and it's pretty lengthy, so take a look at when you get the chance. Interesting stuff.

http://www.geocities.com/sushiman2/GROU ... DDRAFT.pdf

-Sunny