Massachusetts Pursues Mandatory Health Insurance

As health care costs rise and with little leadership from Washington, at least 20 states are now working on their own to expand access to health care. A leading example is Massachusetts, which is preparing to pass a controversial plan that would require all residents to purchase health insurance.

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More and more Americans are living without health insurance. And with little to no action from the federal government, about 20 states are working on their own plans to get more people covered. Take Massachusetts. It's getting close to passing a plan that would require everyone to buy health insurance. The state would subsidize plans for the poor. NPR's Anthony Brooks reports.

ANTHONY BROOKS reporting:

In the Codman Square Health Center in Boston's Dorchester neighborhood, 45-year-old Sean Martin, who suffers from chronic fatigue syndrome, has just seen a doctor. Martin is a self-employed handyman and, like some 45 million Americans, he says he can't afford health insurance.

Mr. SEAN MARTIN: It's $250 a month, something like that. It's beyond the reach of someone who has a working-class type income. After paying rent and everything else, there's not much room left for health insurance.

BROOKS: Martin says he can pay for his routine doctor visits here, but not for the specialists his doctors say he needs. Bill Walczak, the CEO of this urban health center, says patients like Sean Martin are increasingly common--working, poor and uninsured.

Dr. BILL WALCZAK (CEO, Codman Square Health Center): They clean office buildings in downtown Boston at night. They work in restaurants. They do all of the service jobs that we need in order to continue on a daily basis. They really deserve to get coverage.

BROOKS: Walczak says 40 percent of his patients lack health insurance. That's because fewer and fewer employers offer coverage to their workers. A Kaiser Family Foundation study found that five years ago, nearly 70 percent of the nation's employers provided coverage. Today it's down to 60 percent. In Massachusetts, more than a half million residents don't have health insurance, which adds urgency to an effort to fix a broken system.

Governor MITT ROMNEY (Republican, Massachusetts): Everyone recognizes that having a half a million people who aren't insured isn't good for them. And we've got to fix this system to get everybody better health care coverage.

BROOKS: That's Governor Mitt Romney, a Republican who favors a plan that would require everyone in the state to buy health insurance, much like car owners have to buy auto insurance. Those that couldn't afford it would be able to buy cheaper state-subsidized plans, according to Romney.

Gov. ROMNEY: In today's environment, insisting people have insurance would be unfair and untenable. But only in an environment where insurance is finally available at much lower cost for all of our citizens would it be reasonable to say, hey, look, everybody's got to sign up or pay their own way instead of passing on the cost to others.

BROOKS: The idea of a personal mandate is also at the heart of a bill overwhelmingly approved by the Massachusetts House now being negotiated with the state Senate. The House plan also includes a requirement that businesses with 10 or more employees provide health care to their workers or pay a tax. The plan aims to cover virtually all of the state's uninsured residents. John McDonough with Health Care For All, a health care advocacy group, says if approved, the plan would represent a major political breakthrough.

Mr. JOHN McDONOUGH (Health Care For All): The political right likes individual mandates and hates employer mandates. And the political left is generally sympathetic to employer mandates and doesn't like individual mandates. And the default position has always been, OK, so we do neither. And what's interesting now in Massachusetts is that our House of Representatives has approved legislation to say let's do both.

BROOKS: Alan Weil, who heads the National Academy for State Health Policy, calls the Massachusetts plan unique and, if approved, a model for the nation. He also says it represents how many states are searching for a new consensus on a vexing problem.

Mr. ALAN WEIL (National Academy for State Health Policy): Unlike the debate in Washington, which is completely at a standstill, at the state level there is much more of an emphasis on practical solutions and there's more of a willingness go get beyond the ideological. So I think there's much more of an openness to compromise at the state level.

BROOKS: But there are critics. Business groups say the insurance mandate would hurt Massachusetts companies. Others doubt there'll be enough money to help the poor get the coverage they'll be required to buy. And advocates for a simpler, single-payer approach say the plan does nothing to control the runaway costs of a complicated system of private insurance. So says Alice Rothchild, president of the Alliance to Defend Health Care.

Ms. ALICE ROTHCHILD (President, Alliance to Defend Health Care): The problem is that there's a huge bureaucracy that has grown up to decide what your benefits are, and it's a huge waste that could be spent on actually providing health care. So unless the costs of producing the health care are reduced or controlled, the amount of health care we get is going to be less and less and less.

Mr. McDONOUGH: Guilty, guilty, guilty. It's all true. It is.

BROOKS: Again, John McDonough of Health Care For All. Despite that admission, he supports the House plan because he says there is no political will to dismantle the current system of private health insurance.

Mr. McDONOUGH: And I refuse to accept the notion that if somehow we could get 500,000 uninsured in Massachusetts covered, that that's chump change.

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BROOKS: At the Codman Square Health Center in Dorchester, CEO Bill Walczak reluctantly agrees. He'd like to see a simpler, single-payer system, but he also wants to see his patients get the coverage they need.

Dr. WALCZAK: And that's really, really important. Maybe someday we'll be able to have a system of care that eliminates a lot of the bureaucracy and a lot of the administrative overhead and goes to a single payer. But for right now this is a major step forward.

BROOKS: Anthony Brooks, NPR News, Boston.

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