After years of compromise and debate, Massachusetts Governor Mitt Romney yesterday signed into a law a sweeping health care bill designed to virtually guarantee health coverage to the more than 500,000 uninsured residents in the state by 2010.
The bill, which is being hailed as one of the biggest steps toward universal coverage in United States history, has not yet been finalized.
Romney vetoed eight provisions of the bill, an action that drew strong criticism. The overall reaction to the bill, which requires contributions from both employers and individuals, however, has been overwhelmingly positive.
"As I see it, healthcare is a right, not a privilege," Democratic State Representative Carl Sciortino Jr. (LA '00), who is in favor of the legislation, told the Daily.
"I am very hopeful that this will actually be a first in the nation and put Massachusetts in the forefront of providing universal health care to its citizens and I think this can be a national model," he continued.
The bill, approved last week by an impressive 154-2 vote in the State House of Representatives and a 37-0 decision in the State Senate, aims to make Massachusetts the first state in the nation to provide universal health care.
The most important part of the provision that Romney vetoed requires employers who do not currently pay for health care for their employees and employ eleven or more people to contribute $295 per year, per employee.
Sciortino says that this measure is essential to the success of the bill.
"The Democratic-led legislature has achieved a delicate balance obtaining universal health care," he said. "You can't take out one of the legs of the stool and have the stool still stand."
Sciortino said that Romney made a poor choice, especially considering the Governor's use of the bill to generate national attention.
"I think this is an embarrassment for Romney," he said. "He's going to go around the country touting the Massachusetts reform plan, but he [removed] a key provision. It doesn't work without this provision."
Aside from their necessity, Sciortino also said that the provisions will help repair many insurance-related inequalities.
Currently, uninsured residents can receive free care using money from the Uncompensated Care Pool, which is funded by taxpayers and employers who do offer health care to their employees.
"In a sense, the $295 is leveling the playing field," he said, because people whose employers do not pay for insurance still benefit from the pool.
"Their employees are still going to the emergency room and their coverage is paid for by taxpayers and by employers who pay for health insurance," he said. "That subsidy is in the amount of $295 per employee."
Sciortino said that he expects the House and Senate to override Romney's veto. The Governor's press office could not be reached by press time to comment on this possibility.
Apart from the mandatory employer contributions, the new health care bill also requires Massachusetts citizens who can afford health care to purchase it.
Those who do not will be subject to tax penalties.
State citizens living under the Federal Poverty Level will be eligible for the new Commonwealth Care Health Insurance Program, which will give them access to free health care.
Citizens that are above the Federal Poverty Level, but by less than 300 percent, will be provided insurance on a sliding scale.
According to Sciortino, this combination of employer and employee responsibility is necessary.
"This bill balances the goal of universal health care by requiring universal responsibility, and universal responsibility in this bill includes the government, individuals, and the business sector," he said.
Not all legislators, however, are convinced of the necessity of such measures. According to Republican State Representative Daniel Webster, one of the two House members who voted against the bill, the legislation sends a bad signal to businesses.
"I think we're sending the wrong message to businesses in Massachusetts right now if we're going to further tax them. We're losing jobs in Massachusetts right now and not creating new ones," Webster told the Daily.
Republican Representative Jeffrey Perry, the other House member to vote against the bill, feels that the legislation is an inappropriate governmental intrusion.
"I don't know where in society we reach the point where government has the power and ability to mandate to businesses what kind of fringe benefits [they give] to employees," he told the Daily.
He said that incentives would be a much more effective way to accomplish reform than the current system of
penalties.
"I think it's inherently wrong for the government to use the power of the government when they haven't even made a good-faith effort to use positive incentives to get individuals to solve their own problems," he said.
Perry said that tax breaks to those who purchase insurance would be preferable to the current plan. "[We] could have encouraged businesses to provide insurance and encouraged individuals to buy it on their own by having tax benefits," he said.
He said that this bill also sets a dangerous precedent. "To me, that is a significant step toward socialism ... I'm concerned about what's next," he said.
Others feel that the bill may not go far enough. According to Dr. Margaret Higham, the Medical Director at The Tufts University Health Services, the health care available to lower income citizens would still be inferior to the insurance accessible to the wealthy.
Higham said that in an ideal situation, everybody would have the same access.
"It's going to be different for people at the bottom of the spectrum," she said. "I think it all has to be brought to the middle, but that includes limiting benefits at the top."
Other parts of the bill include attempts to make health care more practical and affordable for the 19-26 year-old population through the Commonwealth Health Insurance Connector.
According to Sciortino this is one way bring this age group into the system. "This population is often the population that is reluctant to buy health insurance," he said.
Higham said that this provision is more likely to help young adults in that age group who do not attend college.
"It's the kids that aren't in college [in] this age group that lack coverage. They lack totally," she said. College students are already required to have insurance in Massachusetts and most colleges provide affordable options.
Despite all of its goals, however, it is unlikely that the legislation will lead to 100 percent coverage, but more likely approximately 95 percent.
Funds will still be available for the uninsured. The current Uncompensated Care Pool will be replaced by the Health Safety Net Fund.
According to Democratic State Representative Patricia Walrath, the House Chair of the Joint Committee on Health Care Financing, as more people become insured, less money will need to go into that fund.
Walrath said that the exact amount of money available in future years following the creation of the fund will be a budgetary consideration. "[The funding] will go down each year. But again that would be subject to the budget because that money goes in as a budget contribution each year," she told the Daily.
The funds available will decrease by $110 million in 2008 and an additional $180 million in 2009.
According to Perry, such funds will always be abused, especially for those who do not fill out a tax return, either because they are here illegally or for other reasons.
"If you're not filing a state income tax return...[there will] be no enforcement mechanism to get you to purchase health insurance but you'll still have access to the hospitals because they're not going to deny anybody emergency health care, and those are the individuals who are going to get access to the free pool," he said.
According to Sciortino, the process is not expected to work out flawlessly. "I think we all expect there will be bumps in the road and will address them as they come along," he said.
He said that if all goes well, this bill could create a national model for other states to follow. "I think that people are going to be watching with a lot of interest as to how this unfolds."
