Massachusetts Legislature Passes Bill To Require Health Coverage -AND- Massachusetts Health Coverage Bill Could Influence Other Efforts

CAL/AAEM News Service calaaem_news at
Sun Apr 9 21:34:28 PDT 2006

Massachusetts Legislature Passes Bill To Require Health Coverage

Source: California Healthline (
Date: April 5, 2006 

Massachusetts lawmakers on Tuesday approved legislation aimed at expanding health
coverage for the state's uninsured residents by requiring all residents to buy insurance,
the Washington Post reports. The Senate voted 37-0, and the House voted 154-2 to approve
the bill after "two years of politicking and several months of backroom negotiations,"
according to the Post (Fahrenthold, Washington Post, 4/5). 

With the bill, legislators hope to cover 90% to 95% of the state's 500,000 to 600,000
uninsured residents over three years (Helman, Boston Globe, 4/4). The legislation calls
for uninsured residents by July 1, 2007, to purchase new, low-cost health insurance plans
or forfeit their personal state tax exemption -- worth about $150 -- in the first year. 

Individuals who do not buy plans in the second year would have to pay a fine equal to
half of the monthly premium of an affordable plan, which could amount to $1,200 annually
(Hechinger/Armstrong, Wall Street Journal, 4/5). The bill would require all residents to
provide details about their health insurance policies on their state income tax returns
in 2008, and those who cannot find an affordable plan could obtain a waiver, the Post

According to state officials, hospitals will continue to treat uninsured patients and
will not enforce the coverage requirement (Washington Post, 4/5). 

New Coverage Options
Uninsured residents with incomes up to 300% of the federal poverty level -- $28,700 for a
single person -- would be eligible for Commonwealth Care, a new state-subsidized program
(Ring, Springfield Republican, 4/4). Through the program, uninsured residents with
incomes lower than 100% of the federal poverty level would be able to purchase subsidized
policies without premiums. 

The policies would require "very small" copayments for emergency department visits and
other care, according to the Post. Residents with annual incomes between 100% and 300% of
the federal poverty level would be able to purchase subsidized policies that have
premiums on a sliding scale. 

The legislation does not specify how much low-income residents will pay for the new,
low-cost policies. A new state agency that will "serve as a liaison between the
government, policyholders and private insurers" in part will determine that amount, the
Post reports (Washington Post, 4/5). 

Legislators hope to cover an additional 207,500 residents through the low-cost plans
(Boston Globe, 4/4). In addition, the plan would provide incentives for insurers to offer
low-cost plans with limited benefits to people ages 19 to 26 (Belluck, New York Times,

The legislation also aims to provide coverage for 92,500 uninsured residents under
MassHealth, the state's Medicaid program, by expanding eligibility requirements for
children and enrolling more eligible adults who have not yet signed up, according to the
Globe (Boston Globe, 4/4). 

Other Provisions
The legislation also would require employers with 11 or more workers to provide health
care coverage or pay an annual fee of $295 per employee. In addition, the measure would
require employers whose uninsured workers repeatedly use EDs to pay between 10% and 100%
of the portion of medical bills exceeding $50,000, the Wall Street Journal reports (Wall
Street Journal, 4/5). 

Legislators said the employer fees would go toward the fund that would subsidize low-cost
policies, the Post reports (Washington Post, 4/5). The fees are designed to raise about
$45 million per year (Boston Globe, 4/4). 

The plan would also allow individuals and businesses with 50 or fewer employees to
purchase insurance with pretax dollars (New York Times, 4/5). 

The bill outlines hundreds of millions of dollars in Medicaid payments under a
pay-for-performance system in which health care providers must show they are meeting
certain quality standards in order to receive the additional dollars. In addition,
hospitals and doctors must show they are reducing racial and ethnic disparities and
health care delivery and outcomes. 

The quality requirements go into effect in July 2007, and hospitals and doctors will
receive an additional $90 million in fiscal year 2007, $180 million in FY 2008 and $270
million in FY 2009. The Executive Office of Health and Human Services and two advisory
groups will specify the performance measures, cost control criteria and the amount of
Medicaid payments at risk over the next year, the Globe reports (Kowalczyk, Boston Globe,

According to the Journal, the bill, which is estimated to cost more than $1 billion
annually, would be funded through $125 million in new state spending, money from existing
programs and fees from businesses, and individuals who do not meet the measure's
requirements (Wall Street Journal, 4/5). The cost also would be funded through $650
million a year in federal Medicaid payments (Springfield Republican, 4/4). 

However the "question remains ... whether the state has moved quickly enough to satisfy
federal officials who had threatened to end $385 million in annual federal Medicaid
funding," the Globe reports. The state "needed to demonstrate substantial progress in
reducing the number of uninsured to continue getting the money, and federal officials had
urged the state to have a plan in place by January," according to the Globe (Boston
Globe, 4/4). 

Comments From Governor, Lawmakers
Gov. Mitt Romney (R), who is expected to sign the bill, said the bill is "95% of what I
proposed." He continued "This is really a landmark for our state because this proves at
this stage that we can get health insurance for all our citizens without raising taxes
and without a government takeover. The old singer-payer canard is gone" (New York Times,
4/5). He added that he likely would "adjus[t]" the employer-fee provision through use of
a line-item veto (Washington Post, 4/4). 

However, the New York Times reports that Romney "did not seem that worried about it,
saying he had been most concerned that the fee not be a payroll tax, as had been
originally proposed." 

Senate President Robert Travaglini (D) said that if Romney vetoes the fee, the
Legislature would override it (New York Times, 4/5). 

House Speaker Salvatore DiMasi (D) said, "This is a very historic moment in
Massachusetts. We will be able to in three years, hopefully virtually insure every man,
woman and child in this commonwealth." 

U.S. Sen. Edward Kennedy (D-Mass.) said, "I think a lot of people in the health community
understood that this was a special moment, and we shouldn't lose it or miss it. I found
that at the end of the day, when it really counted, (legislative leaders) were inspired
to do the right thing" (Boston Globe, 4/4). 

Additional Reaction
Bob Baker, president of the Smaller Business Association of New England, said the
association's members seemed to accept the employer-fee provision, adding, "The notion of
the level playing field, I think from an element of fairness and equity, people are OK
with it, unless it impinges on their ability to pay for it. There hasn't been a hue and
cry among our members." 

James Roosevelt, president and CEO of Tufts Health Plan, said, "I think that [insuring
more people] will help both improve the quality of health care and lower the cost,"
adding, "We would have liked more flexibility in the design of health plans to permit
lower premiums that are affordable for all people" (New York Times, 4/5). 

Paul Ginsburg, an economist with the Center for Studying Health System Change, said by
requiring individuals who can afford to purchase insurance to do so, "[t]hat is where
they are really pioneers" (Appleby, USA Today, 4/5). 

Related Coverage

The Globe on Wednesday examined how "[l]obbyists for hospitals, insurance companies and
other major players in the health care industry were paid at least $7.5 million in 2005"
during the negotiations over the health care reform bill. Major spenders included
pharmaceutical companies, business associations, hospitals and health plans. The "amount
spent on health care lobbying in 2005 is up more than a third over 2004 and far outstrips
what was spent" by the gambling and casino industry during debate over slot machines, the
Globe reports (Helman, Boston Globe, 4/5). 

USA Today on Wednesday looked at examples of how "a growing number of states are thinking
big" and "expanding health care coverage" while "Washington continues to debate
relatively minor changes to the health system." While Massachusetts lawmakers on Tuesday
passed legislation requiring residents to purchase health insurance, Oregon, New Mexico,
California and Arizona are considering proposals to create universal health care
coverage. In addition, Maryland recently passed a law that requires some large employers
to provide health coverage to employees, while Kansas, Maine, Minnesota and others are
"creating ways to help small businesses buy insurance," USA Today reports (Appleby, USA
Today, 4/5).
Broadcast Coverage
NPR's "Morning Edition" on Wednesday reported on the bill. The segment includes comments
from Herman Hamilton, a Presbyterian minister active in the campaign for the bill; John
McDonough, executive director of HealthCare for All; Alan Weil, executive director and
president of the National Academy for State Health Policy; and Michael Widmer, president
of the Massachusetts Taxpayers Foundation (Knox, "Morning Edition," NPR, 4/5). The
complete segment is available online in RealPlayer. In addition, NPR's "All Things
Considered" on Tuesday reported on the bill (Knox, "All Things Considered," NPR, 4/4).
The complete segment is available online in RealPlayer. Expanded NPR coverage of the bill
is available online. In related news, Al Hubbard, director of the National Economic
Council, is scheduled to answer questions about affordable health care and health savings
accounts on Wednesday at 4 p.m. in an "Ask the White House" chat. A transcript of the
chat will be available online. 

For more information, please visit:


Massachusetts Health Coverage Bill Could Influence Other Efforts

Source: California Healthline ( 
Date: April 6, 2006 
Several newspapers on Thursday published articles and editorials addressing the plan
passed by the Massachusetts Legislature on Tuesday that would require all uninsured
residents to purchase coverage by July 1, 2007, and employers with 11 or more workers to
provide health coverage for employees. 

Summaries appear below. 
Boston Globe: The Globe on Thursday examined a "key element" of Gov. Mitt Romney's (R)
original proposal -- "providing low-cost, pared-down coverage for about $200 a month."
Lawmakers "were unwilling to adopt some of the measures that" Romney and "insurers had
counted on to lower premiums," the Globe reports. According to the Globe, lawmakers and
insurance executives on Wednesday said the bill calls for state-subsidized health plans
with average monthly premiums of about $325 for individuals. The state will cover the
cost of the premium for individuals with annual incomes up to 100% of the federal poverty
level and will subsidize premiums for those with annual incomes between 100% and 300% of
the poverty level. A "major question is whether" uninsured residents with incomes over
300% of the federal poverty level who do not qualify for the state-subsidized coverage
"will be able to afford coverage," the Globe reports (Kowalczyk, Boston Globe, 4/6).

BusinessWeek Online: BusinessWeek on Wednesday examined how in approving the health care
legislation, "Massachusetts may have broken the gridlock" of stalled "efforts to extend
health insurance to more Americans." According to BusinessWeek, the bill "marries
conservative and liberal ideas," and "it will surely reinvigorate the ongoing national
debate" (Symonds, BusinessWeek Online, 4/5). 

CQ HealthBeat: CQ HealthBeat on Wednesday looked at how "money is a big obstacle to
replicating [Massachusetts' health care reform] model nationwide" because "[n]ot only
does Massachusetts have a relatively small uninsured population, it also has a relatively
large 'free care pool,' whose funding will be shifted to providing subsidies for the
purchase of insurance," according to analysts. However, "[d]espite questions about
Massachusetts as a model for the nation, the state is clearly now a laboratory that will
be closely watched nationally by those hoping for a compromise on the issue of the
uninsured," CQ HealthBeat reports (Reichard, CQ HealthBeat, 4/5).

New York Times: One of the "most surprising aspects" about the bill's passage "is that it
involved the cooperation of virtually every political stakeholder in the state" because
"Massachusetts has more than its share of political egos per capita," the Times reports.
According to the Times, a "confluence of ... factors," including a threat by the federal
government to cut $385 million in Medicaid funding, "pushed the parties to an agreement"
(Belluck, New York Times, 4/6).


Washington Post: The Massachusetts plan is a "good" and "innovative social policy," a
Post editorial says. Romney, who has said the plan is "a way of achieving universal
coverage without new taxes or a government takeover of the health system, ... deserves
credit for working with a Democratic Legislature to come up with a promising plan, but
not for his rhetoric," the editorial adds. While Romney might be "tempted to argue that
his state offers a model for others," Massachusetts "began with two advantages" -- "an
unusually low percentage of residents who are uninsured and a state-backed pool of money
for compensating hospitals for free emergency care that provided reformers with a ready
source of revenue funds," the editorial states. The editorial notes that "it isn't even
certain that the Massachusetts plan will work on its home turf" (Washington Post, 4/6). 

Washington Times: The Massachusetts health care plan "is a Frankenstein's monster of tax
penalties, expanded government-insurance programs and unfunded mandates," a Times
editorial states. According to the editorial, the "fault of this bill is that it really
isn't 'consumer-driven' at all," but "[p]erhaps the biggest laugher here is that we're
somehow supposed to be impressed with ... Romney's observation that the bill simply
applies the state's auto insurance thinking to medical care." The editorial adds, "The
state's auto insurance market is an overregulated nightmare. It's so bad that even Geico
and Progressive don't offer plans in Massachusetts. A lizard would choke on it"
(Washington Times, 4/6).

Broadcast Coverage
Several broadcast programs reported on the Massachusetts bill:

ABCNews' "World News Tonight": The segment includes comments from Paul Ginsburg,
president of the Center for Studying Health System Change; Romney; a Massachusetts
business owner; and a Massachusetts resident with high health care costs (Weiner, "World
News Tonight," ABCNews, 4/5). Video of a related segment is available online.

APM's "Marketplace": The segment includes comments from Stuart Altman, health economist
and professor of national health policy at the Brandeis University Heller School for
Social Policy and Management; Richard Cauchi, health program director at the National
Conference of State Legislatures; and Uwe Reinhardt, a professor of political economy
Princeton University (Palmer, "Marketplace," APM, 4/5). The complete segment is available
online in RealPlayer. 

CBS' "Evening News": The segment includes comments from Altman and Romney (Regan,
"Evening News," CBS, 4/5). The complete segment is available online in RealPlayer. 

NBC's "Nightly News": The segment includes comments from Ginsburg; Reinhardt; Romney; and
an uninsured U.S. resident (Taibbi, "Nightly News," NBC, 4/5). The complete segment is
available online in Windows Media. 

PBS' "NewsHour with Jim Lehrer": Susan Dentzer, health correspondent for the NewsHour,
reports on the bill (Dentzer, "NewsHour with Jim Lehrer," PBS, 4/5). The complete
transcript is available online. The complete segment is available online in RealPlayer. 

WAMU's "The Diane Rehm Show": The first hour of the NPR-syndicated show on Thursday is
scheduled to include a discussion of the bill. Guests on the program are scheduled to
include Ron Pollack, executive director of Families USA, and Bill Vernon, Massachusetts
state director for the National Federation of Independent Business (Rehm, "The Diane Rehm
Show," WAMU, 4/6). The complete segment will be available online in RealPlayer and
Windows Media after the broadcast.

For more information, please visit:

Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

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