Massachusetts bill requires health insurance or face legal penalties

insane man · Apr 4, 2006

Mass. Bill Requires Health Coverage
State Set to Use Auto Insurance As a Model

By David A. Fahrenthold
Washington Post Staff Writer
Wednesday, April 5, 2006; A01

BOSTON, April 4 -- The Massachusetts legislature approved a bill Tuesday that would require all residents to purchase health insurance or face legal penalties, which would make this the first state to tackle the problem of incomplete medical coverage by treating patients the same way it does cars.

Gov. Mitt Romney (R) supports the proposal, which would require all uninsured adults in the state to purchase some kind of insurance policy by July 1, 2007, or face a fine. Their choices would be expanded to include a range of new and inexpensive policies -- ranging from about $250 per month to nearly free -- from private insurers subsidized by the state.

Romney said the bill, modeled on the state's policy of requiring auto insurance, is intended to end an era in which 550,000 people go without insurance and their hospital and doctor visits are paid for in part with public funds.

"We insist that everybody who drives a car has insurance," Romney said in an interview. "And cars are a lot less expensive than people."

Tuesday's votes approving the bill -- 154 to 2 in the House and 37 to 0 in the Senate -- were the culmination of two years of politicking and several months of backroom negotiations, as rival health-care plans from Romney and the two Democrat-led chambers were hammered into one.

What resulted is a proposal that health-care experts say is unlike any other in the country. What to do about the 45 million Americans without health insurance has flummoxed both the Bush administration, whose proposal for "health savings accounts" fizzled, and that of Bill Clinton, whose sweeping plan for health-care changes fell flat.

On the state level, Hawaii and Maine have programs that seek to offer near-universal access to health insurance, and Illinois last year approved a subsidy plan that will widely increase coverage for needy children.

But no state, experts say, has taken the step of making health insurance coverage a legal requirement. The idea was applauded by Uwe E. Reinhardt, a professor of economics and public affairs at Princeton University, who said that he has long believed that the American system of allowing uninsured patients to receive care at the government's expense was nothing more than "freedom to mooch."

"Massachusetts is the first state in America to reach full adulthood," said Reinhardt, noting that the new measure is a move toward personal responsibility. "The rest of America is still in adolescence."

As simple as the idea sounds -- buy insurance or else -- the proposal is complex and, in some cases, still unfinished. For instance, it leaves the task of determining exactly how much some low-income residents will pay for their new, more affordable policies to a new agency that would serve as a liaison between the government, policyholders and private insurance companies.

Because of that uncertainty, some still worry that the residents required to buy insurance would not be able to.

"Who defines what's affordable?" said the Rev. Hurmon Hamilton, a minister in the Boston neighborhood of Roxbury and a leader in an interfaith organization that has pushed for health-care changes.

Another aspect that may change is the $295 annual fee that the bill would require companies to pay for each employee they do not provide with insurance. Legislative leaders have insisted that this money be fed into the pool that would subsidize low-cost policies for the uninsured, but Romney said that would be unnecessary.

"That's likely to be adjusted by me," he said -- potentially through the use of a line-item veto.

This is how Massachusetts leaders envision the plan would work:

Uninsured people earning less than the federal poverty threshold would be able to purchase subsidized policies that have no premiums, and would be responsible for very small co-payment fees for emergency-room visits and other services. Those earning between that amount and three times the poverty-level amount would be able to buy subsidized policies with premiums based on their ability to pay. Though no maximum premium is set in the bill, legislators' intent seems to be for it to top out at about $200 to $250 per month.

All residents will have to provide details about their health insurance policy on their state income tax returns in 2008. Those who do not have insurance would first lose their personal state tax exemption, perhaps worth $150, and later face penalties equal to half the cost of the cheapest policy they should have bought. That might work out to $1,200 per year, officials said. Those who cannot find an affordable plan could obtain a waiver.

Enforcement of the requirement will not be done by hospitals, officials said: They will treat uninsured patients as before.

The bill's passage was celebrated as a victory in the state legislature, with House Speaker Salvatore F. DiMasi (D) telling colleagues that they had succeeded where other states had failed.

"We did something to solve the problem," he said.

The same message might provide a political boost to Romney, who is considering a presidential run in 2008. By proving he can work with Democrats, and find a health-care solution that relies on the private sector, Romney can portray himself as an executive who can work across the aisle in harshly partisan times.

"It might help him to say, 'Look, I have a solution for health insurance,' " said Julian E. Zelizer, a professor of history at Boston University.
© 2006 The Washington Post Company
http://www.washingtonpost.com/wp-dyn/content/article/2006/04/04/AR2006040401937_2.html

Deckard · Apr 4, 2006

Well, this will be interesting to follow. Can't afford health insurance? Millions of otherwise middle class Americans aren't covered because their spouse's job doesn't allow it, or makes it prohibitively expensive. Now the great state of Massachusetts is going to get everyone there health insurance, or else. That will either be a testament to Yankee ingenuity, or a train wreck.

Keep D&D Civil.

geeimsobored · Apr 4, 2006

I've been a big fan of a two-tiered health insurance system for sometime now and to me it seems like the only realistic solution that anyone has come up with.

Full government funded health insurance would be a disaster both in terms of the amount required by federal spending, the new federal health bureaucracy, and the usual fraud and other problems that will waste billions. Not to mention, this would obliterate most of the private insurance industry and would have some serious economic costs.

At the same time, the status quo doesn't work. The health insurance disparity is rising. Corporations can't afford the higher prices anymore and individuals are struggling to keep up with it as well. Millions are uninsured or underinsured and their ranks are growing. Most would say health insurance is a privilege and not a right but considering we guarantee health insurance for the poor (medicaid) and the elderly (medicare) there's no reason to deny those in the middle or at least not do something to help.

Consequently, this type of system seems to be the only solution I've seen. Make health insurance mandatory for all people like auto insurance and if some can't afford it, have the government fill in the void in some capacity. This would at least minimize the bureaucratic overhead and would keep the private insurance industry intact. Not to mention, it would also keep our private system of health care that has made our health care system so great. It seems like a fair compromise between free market health care and social, government funded medicine.

MR. MEOWGI · Apr 5, 2006

We need to try something.

rodrick_98 · Apr 7, 2006

well you knew some of the extreme left would cry about it... talk about trying to be bi-partisan sheesh.

http://news.yahoo.com/s/ap/20060406/ap_on_re_us/health_care

Mass. Health Care Plan Riles Some Liberals

By STEVE LeBLANC, Associated Press WriterThu Apr 6, 7:18 PM ET

The most radical portion of Massachusetts' move toward universal health care — a requirement that all residents carry insurance — is giving indigestion to some who view it as a breathtaking expansion of government power.

"This is the first time in the country's history where simply by virtue of living somewhere you are mandated to purchase a product," said Michael Tanner, of the Cato Institute, a Washington-based think tank.

Supporters of the idea, including Republican Gov. Mitt Romney, cite the mandate as a pillar of the health plan because it forces individuals to take responsibility for their health care.

Many conservatives are embracing the so-called individual mandate, but some liberals and unions are suspicious. They typically prefer assessments on employers, which the Massachusetts plan also includes.

AFL-CIO President John Sweeney called the mandate "unconscionable" and accused Massachusetts of taking "a page out of the Newt Gingrich playbook."

"Forcing uninsured workers to purchase health care coverage or face higher taxes and fines is the cornerstone of Mr. Gingrich's health care reform proposals," Sweeney said.

Romney and other supporters of the mandate say it spreads the burden of covering the uninsured among ordinary citizens, business and government. Romney is expected to sign the bill, though he may veto a $295-an-employee fee for businesses that don't offer insurance.

Romney, a possible candidate for the 2008 Republican presidential nomination, has compared the individual mandate to car insurance, which the state requires for everyone who owns a car. Massachusetts, under the bill, will also require everyone to have health insurance.

According to Tanner, that's a false comparison.

"Driving has always been seen as a privilege that can be revoked," he said. "This is making me buy a product simply by virtue of breathing."

What no one can say for sure is how many of the estimated 500,000 uninsured people in Massachusetts would be subject to the individual mandate — in effect, how many earn enough to buy insurance but don't.

That, according to John McDonough of Health Care for All, a state advocacy group, is one of the complex bill's many unanswered questions.

"Whether it will work out or not, we don't know," McDonough said. "No state has ever gone down this road."

The bill, a dense 145 pages, is still in the works. Some of the grittier details, such as exactly what it means to be able to afford insurance, will be sorted out when the actual regulations are drafted.

Still, there are enough details to win over supporters and perturb opponents.

Under the plan, which would take effect in July 2007, everyone who files a state tax return, beginning in 2008, will have to indicate if they have health insurance.

The bill also requires Medicaid and private insurers to turn over to the state lists of their enrollees each month.

Anyone deemed able to buy insurance, but who is still uninsured, will face increasing penalties.

For example, during the year they would lose the ability to claim a personal exemption on their state tax returns. That would cost an individual about $189 and a couple filing jointly about $378.

The poorest residents — single adults making about $9,800 or less — will get access to insurance with no premiums and no deductibles.

The bill also includes an appeals process.
Click to expand...

MadMax · Apr 7, 2006

Deckard said:

Now the great state of Massachusetts is going to get everyone there health insurance, or else. That will either be a testament to Yankee ingenuity, or a train wreck.

Keep D&D Civil.
Click to expand...

it's not a state. it's a commonwealth.

Cohen · Apr 7, 2006

geeimsobored said:

...
Full government funded health insurance would be a disaster both in terms of the amount required by federal spending, the new federal health bureaucracy, and the usual fraud and other problems that will waste billions. Not to mention, this would obliterate most of the private insurance industry and would have some serious economic costs.
Click to expand...

Medicare and Medicaid ... can you guess what % of Health Care is already 'funded' by the government?

Do you understand how gov-funded healthcare and socialized medicine are very different?

As for Federal Spending, business tax increases and decreased healthcare fees would cover Universal Coverage. As for healthcare fraud, it would decrease. Insurance companies get gamed all of the time, but gaming Medicare is risking extended prison time.

As for bureaucracy, that is a serious concern. We can see where the last (anti-business) Administration practially shut down Medicare HMOs, costing seniors more $$$ and reducing benefits. Then this Administration (pro-business) brings them back, then screws everything up by blaming all the industry's ills on litigation when one of the major culprits for healthcare inflation...drug cost inflation...not only is not managed but actually worsened by a bone-headed Medicare drug program that only benefits major election contributors (the Pharmaceutical companies).

I would like to see direct funding of Universal Care, along the lines of Social Security...but with more protections so the Congress cannot touch the funds for any other purposes. Then have something akin the Fed managing the program w/o politcal intervention (I know...good luck).

At the same time, the status quo doesn't work. The health insurance disparity is rising. Corporations can't afford the higher prices anymore and individuals are struggling to keep up with it as well. Millions are uninsured or underinsured and their ranks are growing. Most would say health insurance is a privilege and not a right but considering we guarantee health insurance for the poor (medicaid) and the elderly (medicare) there's no reason to deny those in the middle or at least not do something to help.
Click to expand...

I agree w/ this.

Consequently, this type of system seems to be the only solution I've seen. Make health insurance mandatory for all people like auto insurance and if some can't afford it, have the government fill in the void in some capacity. This would at least minimize the bureaucratic overhead and would keep the private insurance industry intact. Not to mention, it would also keep our private system of health care that has made our health care system so great. It seems like a fair compromise between free market health care and social, government funded medicine.
Click to expand...

Again, social <> government funded medicine, and there are other, more reasonable solutions than forcing the problem on the people.

This is abdication. The responsibility lies in the gov to solve the ills of the industry before forcing this mess on the back of the people.

pgabriel · Apr 7, 2006

about two and a half years ago i read an tnteresting column on health insurance. it said the reason companies started providing health insurance is that during wwII, the gov't put wage caps on companies to prevent certain industires from hiring people needed to work in industries helping the war effort. in other words there was a high demand for labor driving up labor costs.

so companies in order to get around the wage caps offered benefits like health insurance. its kind of ironic that we have come full circle on this issue. one of the things the column pointed out or argued was that we as americans have taken advantage of health insurance. something I tend to agree with. health insurance costs have gone up, not because of cigarettes or other issues the gov't would have you to believe. they have gone up because everytime someone's kid gets the sniffles they run to the doctor.

the column argued that before health insurance, people would go to the doctor as a last resort. I kind of agree with the columnist that the biggest problem with health insurance is that we as americans have over used it.

and it kind of leads me to another point, I think there are simple solutions to problems like health insurance, like requiring a penalty or people to pay for visits that are deemed not neccessary. I think there is a simple solution to social security, raise the retirement age. when FDR instituted ss legislation. people retired from their jobs lived 5-10 years and died. now people are living 30 years after retirement. so simply raise the retirement age.

but you will never hear a politician come up with those solutions, because people with health insurance vote, and people on social security vote, so you will never hear that solution, because a politician would be hanging him or herself. its the fatal flaw in our democracy. sometimes we as americans need strong medicine, no pun intended, and we don't get it, because we will just vote for the guy who won't give it to us.

Deckard · Apr 7, 2006

MadMax said:

it's not a state. it's a commonwealth.
Click to expand...

Oh, hell... I knew they were Commies!!

Keep D&D Civil.

StupidMoniker · Apr 7, 2006

pgabriel said:

but you will never hear a politician come up with those solutions, because people with health insurance vote, and people on social security vote, so you will never hear that solution, because a politician would be hanging him or herself. its the fatal flaw in our democracy. sometimes we as americans need strong medicine, no pun intended, and we don't get it, because we will just vote for the guy who won't give it to us.
Click to expand...

"A democracy is always temporary in nature. It simply cannot exist as a permanent form of government.

"A democracy will continue to exist up until the time that voters discover they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidates who promise the most benefits from the public treasury. The result is that every democracy will finally collapse over loose fiscal policy (which is) always followed by a dictatorship."
Alexander Tytler

pgabriel · Apr 7, 2006

StupidMoniker said:

"A democracy is always temporary in nature. It simply cannot exist as a permanent form of government.

"A democracy will continue to exist up until the time that voters discover they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidates who promise the most benefits from the public treasury. The result is that every democracy will finally collapse over loose fiscal policy (which is) always followed by a dictatorship."
Alexander Tytler
Click to expand...

its economics and human nature.

pirc1 · Apr 7, 2006

pgabriel said:

its economics and human nature.
Click to expand...

That is why I support fiscal conservatism, but where do you find such extinct animals today?

MR. MEOWGI · Apr 7, 2006

I just want affordable healthcare and if that kills some rich people I dont care.

MR. MEOWGI · Apr 7, 2006

pgabriel said:

health insurance costs have gone up, not because of cigarettes or other issues the gov't would have you to believe. they have gone up because everytime someone's kid gets the sniffles they run to the doctor.
Click to expand...

If they get more business why would that lead to higher costs instead of lower? I think the main reason they charge more now is because they can.

pgabriel · Apr 7, 2006

MR. MEOWGI said:

If they get more business why would that lead to higher costs instead of lower? I think the main reason they charge more now is because they can.
Click to expand...

because its not your co-pay that pays for the doctor's visit, its the portion that the insurance company pays. so everytime you pay $20 bucks, they pay $300. and they have to eventually recoup or these insurance companies will go bankrupt. the doctors are benefiting from the increase in business.

MR. MEOWGI · Apr 7, 2006

StupidMoniker said:

"A democracy is always temporary in nature. It simply cannot exist as a permanent form of government.

"A democracy will continue to exist up until the time that voters discover they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidates who promise the most benefits from the public treasury. The result is that every democracy will finally collapse over loose fiscal policy (which is) always followed by a dictatorship."
Alexander Tytler
Click to expand...

Ill vote for my "free gift" if its the only option I have to get affordable healthcare.

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