Massachusetts Health Coverage Mandate Should Inform Presidential Candidates
The New York Times on Sunday examined the progress ofthe
More than 200,000 previously uninsured residents have enrolled in insuranceplans, but state officials estimate that possibly up to twice as many residentshave not enrolled in any type of coverage. Meanwhile, enrollment in thestate-subsidized health plan has been greater than expected, and the state programcould face a $150 million budget shortfall if enrollment continues at itscurrent rate. Concerns also have been raised about projections that stateinsurers plan to increase rates by 10% to 12% next year -- twice the nationalaverage for 2007. According to the Times, such hikes "wouldundercut the plan's secondary goal of slowing the increase in healthcosts."
Jon Kingsdale, executive director of the CommonwealthHealth Insurance Connector Authority, said, "We're going to be very aggressivein trying to get those numbers down to single digits," adding, "If wecontinue with double-digit inflation, I don't think health care reform issustainable."
The experience in
Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Foundation's Commission on Medicaid and the Uninsured, said it has become broadly accepted"that an individual mandate is the only alternative to governmentprovision of coverage if you hope to achieve universal coverage." Accordingto Kingsdale, "There's good evidence, whether it's buying auto insuranceor wearing seat belts or motorcycle helmets, that mandates don't work100%." He added, "We're talking about how close you can get to 100%,and to me, it's pretty evident you can't get as close without the mandate asyou can with it" (Sack, New York Times, 11/25).
The state required about 62,000 employers with eight or more workers to reportby Nov. 15 whether they met the insurance requirement. Of those businesses,nearly 44,000 were small enough to be exempt from the requirement, and the restsaid they already offer coverage. About 18,000 employers have not yet reportedtheir insurance status, and the state will impose the penalty on businessesthat do not report whether they provide insurance, according to stateCommissioner of Health Care Finance and Policy Sarah Iselin.
The state will collect about $5 million in penalties this year -- "farless" than the $24 million previously estimated, "which could resultin another financial shortfall for health care reform," the Globereports. The state Legislature originally estimated that the business penaltywould generate $45 million last year and $36 million this fiscal year. However,the state did not collect any of the penalties last year, and Gov. DevalPatrick's (D) administration then downgraded this year's estimate to $24million. Although money from the penalty "is a small part" of theestimated $1.8 billion annual cost of the law, there are other signs of budgetstrains, including the pace of enrollment in the state-subsidized healthinsurance plan -- which could cost $147 million more than expected this year --and proposed federal rules that could reduce Medicaid funding by more than $100million.
Some advocates have called for stricter rules on businesses, saying thatemployers should be required to provide coverage to at least half of their workforces and contribute more to premiums. John McDonough, executive director of Health Care for All, said the rules set forth by the administration of former Gov. MittRomney (R) have "permitted many employers providing little or no coverageto their workers to escape fair share responsibility. For example, if I offerto pay one-third of the premium and none of my employees take up the offer, Iescape liability under the law even if I'm not covering anybody," adding,"This means that taxpayers are carrying and will carry a larger-than-anticipatedburden." However, state Senate President Theresa Murray (D) said,"Employers are obviously doing their part, and individuals are also takingtheir responsibility seriously" (Dembner, Boston Globe,11/22).
Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.