Mass. Leads Nation with State-Wide Health Plan

Massachusetts Gov. Mitt Romney signed legislation Wednesday that would make his state the first in the nation to require every resident to have health insurance, just as drivers must have automobile coverage.

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From NPR News, this is NEWS AND NOTES. I'm Farai Chideya, in for Ed Gordon.

Yesterday, Massachusetts Governor Mitt Romney signed into law the nation's very first universal healthcare bill. The legislation aims to cover 95 percent of the state's uninsured population. Under the new law, all residents would be required to buy health insurance. The state would provide subsidies to lower income residents to help purchase health coverage.

As Rachel Gottbaum reports, this kind of a mandate has never before been attempted in the United States, and no one is sure whether Massachusetts will succeed with its ambitious plan.

RACHEL GOTTBAUM reporting:

At the end of the day, the Landais(ph) family is sitting in the living room of their Boston apartment. Joseph Landais takes out the bill he received when he brought his 14-year old doctor to have her swollen eye looked at.

Mr. JOSEPH LANDAIS: She had a problem with the eyes. The bill is $265.00. Just one visit, they charged me $265.00.

GOTTBAUM: Landais is retired from his job of 35 years as a janitor at a nearby hospital. He and his wife are both originally from Haiti. Joseph Landais has no health insurance, and neither do his three children. They were dropped from the state's Medicaid roles because their mother Ju-Ju(ph) makes too much money.

Ju-Ju Landais earns $50,000 a year working her two jobs as a nurse's aide. She said she cannot afford the $996.00 a month it would cost her to buy health insurance for her family.

Ms. JU-JU LANDAIS: I cannot afford health insurance. It's too expensive.

GOTTBAUM: So your kids were covered, but they're not covered anymore?

Ms. LANDAIS: No. They said their mother makes too much money. They not qualify for health insurance, also. So they discontinued their health insurance. I don't know. I've been worried for a long time, because, you know, when you have kids, you should take them to the doctor's appointment, but you worry because if you take them, they'll send you the bill. You will not be able to afford the bill. So, you're afraid to take your kids to a doctor's appointment.

GOTTBAUM: The Landais family would likely benefit under the state's new healthcare plan that aims to provide health insurance for all Massachusetts residents. Under the new bill, people who are not poor enough to receive Medicaid, but who make less than $50,000 a year for a family of three would be able to get subsidies to buy health coverage. Residents who make more money would be required to get health insurance or face tax penalties. And all would have a choice of plans that the state deemed affordable.

State Representative Patricia Walrath was a main sponsor of the new legislation.

State Representative PATRICIA WALRATH (Democrat, Massachusetts): It requires individuals to have insurance, effective July 1, 2007. It requires employers to also contribute, if indeed they're not providing health insurance for their employees. It also requires the Commonwealth, of course, to chip in money. So, those three groups will have a partnership here in terms of providing health insurance. So, those 550 some odd thousand people will have health insurance. That is a huge accomplishment.

GOTTBAUM: The money to subsidize lower income families will come from the $675 million a year the state gives to hospitals to fund uninsured patients. The Commonwealth will also kick in an additional $125 million a year from its general fund. In addition, employers that don't now offer insurance will be charged a per employee fee to be put into that pool. Most of the details of the new health bill must still be worked out, but many questions are unresolved.

For example, how to dispense the sliding scale subsidies to low-income residents, and how to determine what an affordable health plan actually looks like. The new state mandate does not require residents to buy health insurance unless it is affordable.

Professor JONATHAN GRUBER (Economics, MIT): The difficulty is deciding on what the word affordable means.

GOTTBAUM: That's MIT economics professor Jonathan Gruber. He's advised both Massachusetts Governor Mitt Romney and state legislators on how much money their new health reform would cost.

Prof. GRUBER: Economics doesn't tell us what affordable means. Economics can tell us what different plans can mean in terms of what people have to spend to share their income. Affordable is a purely political concept that has to get defined as this process rolls forward.

GOTTBAUM: And politics may stall the implementation of Massachusetts' new health plan. Yesterday, Governor Mitt Romney vetoed the employer fee. But state legislators say they are likely to override the Governor's changes.

For NPR News, I'm Rachel Gottbaum, in Boston.

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