Mass Health Care Part 2: Critiques of the New Policy

While the state legislature and governor’s office were celebrating Massachusetts’ new universal health care policy, health care experts across the nation were looking more closely at the legislation and critiquing its shortcomings.

No one argues that the attempt is bold, decisive, and hopeful, but some are starting to wonder if the plan will really work.

What is the new Massachusetts health care plan?

Massachusetts stunned the healthcare industry and Capitol Hill with a groundbreaking bill that promises health insurance to nearly every Massachusetts resident by 2007.

The legislation was a truly bipartisan effort, with support among state and federal lawmakers.

The bill is a combination of Republican and Democratic proposals and therefore satisfies both parties’ philosophies of health care.

Collaborating philosophies

The Democratic philosophy of health care emphasizes that all Americans are entitled to health care. They believe that government should provide health coverage to the less fortunate.

The Republicans’ philosophy emphasizes that health care should be largely separate from the government. They favor a free-market approach in which private competition, not public funds, works to increase quality and lower costs. Further, Republicans believe in individual accountability -- individuals should be responsible for their health and make good use of their resources.

The Massachusetts near-universal health care proposal would incorporate both of these philosophies by expanding the government’s role and individual responsibility.

The bill requires every Massachusetts resident who can afford it to buy health coverage or else pay income tax penalties. The penalty money would then be used to help lower-income workers to afford health care. The government would subsidize premiums for people who earn up to 300 percent of the poverty level ($60,000 for a family of four) and provide free health care to those below the federal poverty line ($20,000 for a family of four).

Further, the legislation helps small businesses and the self-employed afford health care by allowing them to buy insurance with pre-tax dollars.

What are the main critiques?

Critics of the Massachusetts plan argue that the state won’t be able to fund it.

The plan presupposes that health care premiums can be held to $2,400 per year with a cap of $2,100 on deductibles. Many experts say that this assumption is implausible and that if health care costs continue to inflate rapidly, the plan could come to a quick and bitter end.

Higher-than-presumed deductibles could result in fines for people who can’t afford health insurance, which hardly seems fair, opponents say.

Critics go on to say that the state’s contribution to the program is meager compared with individuals’ and businesses’ payments. But businesses that don’t cover their employees won’t have much to worry about. The bill fines them a mere $295 per employee per year, which does nothing to compel companies to comply, opponents say.

The program can’t work without doing something to curb health care costs, critics argue. By allowing the system to remain as it is and creating a new bureaucracy (the Commonwealth Health Insurance Connector, which would oversee insurance plans), the plan guarantees a serious financial strain for the state, businesses, and individuals, opponents say.

Proponents of the plan argue that universal health coverage innately lowers costs. Since the uninsured won’t be making expensive emergency room trips that inflate the cost of care for all, the plan does work to lower expenses. Further, more young and healthy people are in the pool, helping to pay for the old and sick.

History repeats itself

Critics of the plan say, "It didn’t work then and it won’t work now." To what are they referring? A1988 attempt at universal health coverage for Massachusetts.

That year, Governor Michael Dukakis happily signed what was touted as the first-ever universal health care plan, and the news of his groundbreaking legislation propelled him to the presidential race.

Like Dukakis, current Governor Mitt Romney has presidential aspirations. And some argue that Romney’s bill has the same problems as Dukakis’: It doesn’t anticipate a quick rise in health care costs; it doesn’t account for the possibility of a federal cutback in Medicaid funding; it could fail if the legislature doesn’t properly fund the law. These problems eventually killed the 1988 law, and an argument over the employer tax didn’t help.

Then, as now, the state proposed to fine businesses that do not cover their workers. In 1988, companies fumed over this provision and kept it from taking effect.

Governor Romney is worried about a similar backlash from the business community. He has therefore vetoed the $295 fee, though the legislature promises to override the veto.

A government/business fight over this fee could upset the delicate bipartisan compromise that supports the new law. However, this time around the business community seems more open to it.

Other criticism

Since the new law requires all residents to have health insurance, some argue that it is an unnecessary expansion of government power. They say that individuals should be able to choose whether or not they are insured.

Proponents argue that the uninsured affect everyone’s health care costs, so it isn’t simply a matter of individual freedom.

What do you think?

Should a state be able to require health insurance of its residents? What is the best way to fund universal health care? How many people are uninsured in your state? What do you want your state representatives to do about it? What is your experience with health insurance as an individual, family, employer, or uninsured person?

Your input matters

Your representatives DO care what you think. Especially now -- 2006 is an election year and many representatives will be looking to reconnect with their constituents. Let your congressmen and women know what you think! Give your senators a piece of your mind! To find your reps, click here.

About WomenMatter

WomenMatter is a place to discuss life issues with other women. We don’t want to wedge women apart, but rather bring them together to dialogue. To participate in our blog, click here.

WomenMatter is the place where we can take one issue at a time, match what we do about it every day of our lives to the facts of the bigger system that we all live in and recognize that every idea for making it better has tradeoffs.

WomenMatter is dedicated to empowering women to participate in the political process. To do this we have invested in the most in-depth NONPARTISAN information, because we trust each woman to make up her own mind.

• We track nine issues every week and update this website several times a week.
• We launch after school GirlsMatter Clubs in middle and high schools to grow the next generation of politically aware women through a full curriculum and startup kit on girlsmatter.com.
• We do continuous research to make sure that we are meeting the needs of women across the country of all ages, races, incomes, preferences, and religions.

We offer all our services free of charge without memberships or subscriptions. To help us maintain this work - not just in election years but as a continuing part of women’s lives - please make a tax deductible donation, click here.

Posted on: 4/24/2006