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Universal Health Coverage, The Massachusetts Way

August 30, 2008; New York Times; Universal Health Coverage, The Massachusetts Way; editorial.

The pioneering Massachusetts program to provide health insurance for all citizens looks more and more successful with each passing month.

The number of uninsured has dropped — Massachusetts now has the lowest rate in the nation — and so have the number of those who turn to costly emergency rooms for routine care. And while the state has had to seek additional sources of revenue — mainly because of the program's popularity — the gains in the first 21 months suggest that the plan could become a model for universal health coverage for other states or the nation.

Massachusetts enacted its ambitious health insurance reform two years ago under bipartisan leadership from then-Gov. Mitt Romney and a Democratic Legislature. Although Mr. Romney distanced himself from the plan during the Republican primaries, he was back to extolling its virtues in an opinion piece for The Wall Street Journal last month.

The plan requires everyone to take out health insurance or suffer a tax penalty and requires employers to offer coverage or pay a small assessment if they don't. Low-income residents can enroll in an expanded state-federal Medicaid program or receive subsidies to pay all or part of the premiums for private insurance. Those who earn more than 300 percent of the federal poverty level (about $63,000 for a family of four) receive no subsidy but can buy private policies through a new insurance exchange at much lower rates than before.

More than 439,000 people have taken out coverage since the program began in mid-2006 — two-thirds of the estimated 650,000 who lacked health insurance when the program began.

More than 40 percent of the newly insured purchased private commercial policies without any government subsidies, defying dire predictions that employers would drop their plans and a horde of individuals would drop private policies. What seems to be happening instead is that workers who previously shunned their employers' plans have decided to sign up now that insurance is required.

The big expansion in coverage has yielded a commensurate drop in the number of "free riders," those who use hospital emergency rooms and community health centers for routine care that they don't pay for. The cost of that uncompensated care dropped from $166 million in the first quarter of fiscal 2007 to $98 million in the first quarter of 2008.

Far more people have enrolled far more quickly than expected, driving up the total budget for subsidized care beyond Medicaid to $869 million in the next fiscal year, about half of which will be absorbed by the state and the other half by redirected federal funds. The cost per person is actually less than expected. The program to date is fully financed.

That may still look like a lot of money, but universal coverage is vitally important to enhance the health of previously uninsured citizens. In the long run, full coverage should serve as a springboard toward reforming the health care system to deliver higher quality, more cost-effective care.

Copyright 2008 The New York Times Company

http://en.wikipedia.org/wiki/Single-payer_health_care

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