The Massachusetts legislature has enacted a bill that requires every citizen to have health insurance and provides state subsidies to those who can't afford it.
No other state has ever told its citizens they have to have health coverage, just as they must carry car insurance if they drive.
Beginning next year, people who don't get insurance through their job will have to buy it on their own if the state determines they can afford it. The new law would promote affordable insurance plans and allow people to pay for them with pre-tax dollars. The bill is currently before the state's Republican governor, Mitt Romney. NPR spoke with Romney about the bill and its genesis:
Q: Why did you decide to try to revamp Massachusetts' health care system?
The key insight was this: People who don’t have insurance nonetheless receive health care. And it’s expensive. When the uninsured get sick or injured, they go to the emergency room, and someone has to pay for that. In our state that’s roughly $1 billion a year. So we’re spending $1 billion giving health care to people who don’t have insurance. And my question was, could we take that $1 billion and help the poor purchase insurance, let them pay what they can afford. We’d subsidize what they can’t.
Q: Is $1 billion enough to get everyone insured?
It’s enough, and more than enough. When I put my plan in, we concluded that of the $1 billion we’re currently spending, we’d only need $600 million to make this plan work. We’d have $3 million to $4 million left over. In the legislative plan that’s come forward, they use that money. They use it to add new benefits for Medicaid recipients and to raise fees for hospitals well above the current level. Those kinds of changes mean that they’re planning to use the extra money I had left in a pool to be available if necessary.
Q: Sen. Hillary Clinton (D-NY), who led her husband's health care campaign, said the Massachusetts bill was "commendable." How do you feel about being complimented by Hillary?
I’m always happy to take compliments. Hillary Clinton looked at health care a good long time, and I think came up with something that missed the mark. And instead we’ve come up with something that’s much closer to Republican ideals: reform the market to make the health-insurance marketplace work better. Insist on personal responsibility instead of government responsibility.
Q: How is this health care plan different from what has been previously proposed in the past in Massachusetts?
We put aside the thoughts of a single-payer system or a government-directed system. No. 1, let’s help people to buy private health insurance. No. 2, this time we’re not talking about an employer mandate. And that’s a critical feature. Now they did add an assessment fee to a very small subset of employers that aren’t providing insurance to any of their employees. And that’s probably something I’ll take a very careful look at. But this is in no way a major business tax. And as a result, you’re not seeing the negative response from the business community that had existed in prior efforts to try and reform our health care system.
Q: So the business community is behind this bill?
The business community as well as the insurance leaders and physicians. They all had the same conclusions as we did when we put this together. It works. It’s not 100 percent of the way any of us would like it. But it’s 95 percent of the way each one of us likes it.
Even the business community recognizes that by getting everyone insured, that the burden of the uninsured is no longer going to be passed along to them.
Q: Are you confident that the numbers do work?
A: Well, my guess is the Wright brothers did not build their aircraft and have it fly the first time. They had to make some adjustments. We’ll probably have to make some adjustments as well.
Q: The new policies being offered may be affordable, but will they be so basic they won't meet real medical needs?
These are not stripped-down, bare-bones policies. They include preventative care, primary care, tertiary care. They include mental health care. So it’s the health care that our citizens need and deserve. They do not necessarily have to include mandated benefits such as in vitro fertilization, which can be very, very expensive.
Q: Stepping back, what impact do you think this will have outside Massachusetts?
Around the country, people are watching because they know this is big. Some on the far left don’t like it because it’s not a single-payer universal coverage program. Some on the far right don’t like it because they don’t like government telling people that they need to get insurance. But the great majority of people, both on the left and the right, believe that this is a step forward.
Q: Can this model be used in other states?
My guess is a lot of states will choose to adopt one or another of the measures we’ve put in place here. But most will give it a little time and watch to see what our experience is. That’s the great thing about having 50 states and the principle of federalism. Let us experiment ourselves. Let us learn from one another.