http://www.latimes.com/news/printedition/asection/la-na-healthcare8apr08,1,4400520.story
From the Los Angeles Times
Expansive Health Plan Won't Fit All States
New legislation would insure nearly everyone in
Massachusetts. But experts say the program would be tough to replicate
elsewhere.
By Elizabeth Mehren
Times Staff Writer
April 8,
2006
BOSTON ・After months of negotiations, Massachusetts passed
legislation this week that promises near-universal healthcare coverage ・the
most inclusive plan any state has crafted.
But experts say the state's
unique circumstances will make the measure difficult to replicate.
The
145-page bill, passed Tuesday by the state's heavily Democratic Legislature, is
expected to be signed soon by Gov. Mitt Romney, a Republican who probably will
seek his party's presidential nomination in 2008. The package emphasizes
individual responsibility ・requiring all state residents to obtain health
insurance by July 2007 ・and spreads costs among citizens, employers and
government.
"It is an inspiration for the rest of the nation, but not
necessarily a model," said Drew Altman, president of the Kaiser Family
Foundation in Menlo Park.
Massachusetts is a small state, he noted, with
a relatively low number of uninsured people ・only about 10% of the state. It
has a low unemployment rate and a large base of employers who traditionally have
provided health coverage for workers.
Lawmakers here also have tried to
provide coverage for the uninsured, going back to the 1980s, when then-Gov.
Michael Dukakis signed a universal healthcare plan that later was repealed. And
Massachusetts long has found creative ways to use public programs to pay medical
costs for uninsured people.
But Altman said the most important factor was
the way Massachusetts managed to unite conflicting factions.
"We have had
this Grand Canyon divide about how to solve the healthcare problem," he said.
"And Massachusetts put together a Cuisinart-style package that breaks through
the ideological logjam by borrowing from the left, the right and the
center."
Salvatore F. DiMasi, Speaker of the Massachusetts House of
Representatives, said lawmakers wanted to take advantage of a brief federal
funding window that guaranteed $385 million in annual subsidies if the state
could reduce its uninsured population.
"We didn't let ideologues stand
in our way," he said. "It was more, can we make these principles work, and how
do we make them work by insuring everybody in Massachusetts and reducing
healthcare costs at the same time?"
Massachusetts also managed to
reassert healthcare reform as a critical national issue, said Dr. Robert Blendon
of the Harvard School of Public Health.
"It is a backlash to all the
cutbacks," he said. "It could be the first of the countermoves of healthcare not
being at the top of the agenda, with states just cutting costs and cutting
benefits."
Among its many elements, the Massachusetts plan establishes a
sliding scale to determine who can and cannot afford health insurance. The
measure also creates a health insurance "connector" to link businesses and
individuals with insurance providers.
All state residents who can afford
private insurance will face tax penalties if they do not obtain coverage.
Private insurance companies will be eligible for government subsidies to
increase coverage for children and the working poor. Small businesses that do
not offer insurance will be charged an annual assessment of $295 per employee.
In addition, families will be required to cover dependent children up to age
25.
The state managed to "slice up the problem," said Grace-Marie Turner,
head of a Washington health policy research group called the Galen Institute.
"It said who is uninsured, why are they uninsured, what do they need to
make this work. That is what other states need to look at to make this
work."
In 1974, Hawaii became the only state to introduce an employer
mandate, where businesses must participate in employee insurance plans, said
health policy analyst Laura Tobler of the National Conference of State
Legislatures. Three years ago, Maine unveiled a near-universal healthcare
program that since has encountered a series of setbacks.
Also in 2003,
California's legislature passed an employer mandate that was overturned in a
ballot initiative the next year.
Tobler said that while the
Massachusetts legislation could be a catalyst in California, "the population of
the uninsured in California is larger and more diverse in income," making it
difficult to copy Massachusetts' model.
Rhode Island, New Mexico and
Oklahoma recently expanded their Medicaid programs, Tobler said, and at least 20
other states are considering Medicaid reform proposals. Those states may study
Massachusetts as a test case, she said.
"A lot of other states are going
to look at it and say, 'Hmm,' " Tobler said.
"But Wyoming is not going
to look at Massachusetts and say, 'This would work here,' because the
demographics are so different."
Vermont and Wisconsin also are preparing
healthcare reform efforts, said AARP policy director John Rother. Like
Massachusetts, he said, those states have relatively small uninsured
populations.
"It is unimaginable that Florida, California or Texas could
take this action," he said.
Rother said the Massachusetts healthcare
reform bill is "not exactly a model for the rest of the country ・but it may be
one of several models. It is great that states are making this effort, but when
you get closer to it, it is by no means clear how this is going to turn out. And
the magnitude of the problem is just so very different from state to
state."
Still, Rother said, "Massachusetts has showed that something can
be done. It is not hopeless."
Los Angeles Times
Copyright 2006 Los Angeles Times |