Massachusetts Becomes First State to Mandate Universal Health Care Coverage

Massachusetts lawmakers made history in April, becoming the first state to approve legislation that will require all residents to have some form of health insurance coverage by July 2007. Signed into law by Governor Mitt Romney on April 12, the plan forges a unique compromise between government assistance and personal responsibility, with the cost to individuals and families based on income. The legislation is expected to drive down the cost of insurance for everyone, as public funds are redirected to more effectively cover the state's 515,000 uninsured.

Individuals who earn less than $9,600 annually (the current federal poverty level) will have their premiums waived on private insurance. Individuals who can afford insurance will be increasingly penalized for not buying coverage, beginning with the loss of one's personal state income-tax exemption, approximately a $200 hit. In subsequent years, financial penalties will equal half of the annual premium of an affordable plan (for the uncovered period).

Families earning less than 300 percent of the federal poverty level (approximately $38,500 for a family of three), but who are ineligible for Medicaid, will have their private insurance plans subsidized at a sliding-scale rate. Children whose families earn below 300 percent of the federal poverty level will be covered completely through Medicaid.

The bill was four years in the making and is the fruit of an insurance reform initiative from Gov. Romney (R) and Senator Edward Kennedy (D). The bill essentially is a bridge between stipulations in the House (H.4479) and Senate (S.2282) versions of the legislation.

Despite some looming questions concerning the bottom line, the nearly universal health care plan is being hailed by many as a model for nationwide universal health coverage. And with the Massachusetts House approving the bill by a vote of 154-2 and the Senate by a 37-0 vote, clearly the model is one both Republicans and Democrats can agree on. Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change, suggested in an interview with The New York Times that this compromise is definitely going to be inspiring to other states. "For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

The bill creates several options for both employers and employees. One such option is the Commonwealth Health Insurance Connector, which will connect individuals and small businesses with quality health insurance products. Employed individuals will be able to purchase insurance with pre-tax dollars. In what could prove to be one of the more popular benefits, the Connector allows for portability of insurance as individuals move from job to job. It also allows more than one employer to contribute to an employee's health insurance premium. The Connector will be operated under the authority of the Department of Administration and Finance and overseen by a separate appointed board of private and public representatives.

The uninsured are not the only parties expected to benefit from the legislation. Within the current system, companies that offer insurance to employees also have to pick up part of the tab for the cost of care for the uninsured at hospitals. However, with far fewer uninsured individuals relying on emergency room care, the new plan will vastly reduce ancillary costs to employers. Further, analysts expect the addition of more healthy people to the insured pool will keep deductibles and premiums low for all, as such individuals generally utilize less care.

While the impact of this legislation on the chiropractic profession is unclear as of press time, ACA Executive Vice President, Kevin Corcoran, CAE, suggested that federal health care legislation (see "Advocacy in Action: Profession Mobilizes Against Controversial Health Care Bill" on page 1) may affect chiropractic coverage in Massachusetts and elsewhere:

"The ACA is currently reviewing the proposed Massachusetts insurance legislation to assess its overall impact on the chiropractic profession. However, the ACA has learned from its sources within the U.S. Senate that proposed federal legislation, S.1955, would undermine if not totally negate the Massachusetts plan. S.1955 would permit insurers to sell policies that did not meet certain requirements of current state law, including that provision which assures insurance reimbursement for covered services within the scope of practice of chiropractors (Chap.175, Section 108D, Mass. Gen. Laws). This would, in our view, make it much less likely that patients in Massachusetts would receive needed chiropractic care and defeat the purpose of comprehensive coverage."