ROBERT SIEGEL, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MICHELE NORRIS, Host:
And I'm Michele Norris. This week, California Governor Arnold Schwarzenegger got the attention of every healthcare reformer in America. He proposed that every Californian get health insurance. It was a risky move in part because of the cost. California has more uninsured people than Massachusetts has people.
But Massachusetts is taking its own health reform risks. It's beginning to implement a landmark health law enacted last spring that aims for near-universal coverage. As NPR's Richard Knox reports, things are going well in Massachusetts so far.
RICHARD KNOX: Business is brisk this week at the hotline for Health Care for All. It's a Massachusetts advocacy group that tells people how to enroll in the new program. Kate Bicego runs the hotline.
KATE BICEGO: We've been pretty much back to back with calls all day long. I would say we've had close to 150 calls today because of the start of the new Commonwealth Care Health Insurance Program.
KNOX: This month actually marks the second phase of implementing the new Massachusetts law. Phase one has so far enrolled 34,000 people who are below the poverty line. They'll get excellent coverage with very low out-of-pocket payments. The state pays all the premiums.
Phase two provides subsidized insurance for the near poor who make up to three times the federal poverty level. That's an income of $29,000 a year for an individual, $60,000 for a family of four. Cliff Wayland(ph) of Lowell, Massachusetts, is planning to sign up so he can start taking care of himself.
CLIFF WAYLAND: Last time I went to the doctor a few years ago, I had high cholesterol. So he recommended that I get on Lipitor. But, you know, I can't afford the pills, so I'm not taking it.
KNOX: Wayland is a single father in his fifties with two young kids. He's also a full-time personal care attendant for his brother who's quadriplegic.
WAYLAND: I've been playing kind of the luck game too long. I need to be covered. And I got a lot of people dependant on me, my two small children and my brother. So without me, the whole thing falls apart.
KNOX: Because of the subsidy it will cost Wayland about $40 a month for good health insurance coverage. Massachusetts officials expect to enroll something like 100,000 uninsured citizens in the new program over the next couple of months. That's about a quarter of the state's estimated 372,000 uninsured.
When Massachusetts passed its new law there were an estimated 500,000 uninsured. But even before the new law took effect, the numbers have come down, according to Jon Kingsdale. He directs a new state agency called the Health Insurance Connector. Kingsdale says more people have enrolled in Medicaid recently and more small businesses are offering coverage.
JON KINGSDALE: That's very good news for reform in Massachusetts because none of this is cheap. I mean, healthcare reform is a very expensive proposition, and the fact that the size of that problem just came down by 25 percent makes reform much more affordable.
KNOX: But the critical days for Massachusetts' health reform lie ahead. Later this month, insurance companies have to unveil a new array of unsubsidized health plans for people who make more than three times the poverty level. If Kingsdale's agency deems the new policies affordable, all uninsured citizens will have to buy one starting in July.
If they don't, they'll face a penalty at income-tax time - only about $200 for the current tax year, but in the spring of 2009, state tax authorities will dock them half of what it would have cost to buy insurance. Kingsdale expects sticker shock when people realize what they'll have to pay.
KINGSDALE: We actually had 60 different individuals participate in a whole number of focus groups, and all but one were surprised and then dismayed to find out that they were going to have to buy insurance a year from now.
KNOX: Officials will have to convince them it's more in their interest to buy health insurance than to pay the penalty. But to make insurance affordable from the average citizen's perspective, some think the state will have to expand state subsidies for people making under, say, five times the poverty level. That's around $100,000 for a family of four. After all, an average family policy in Massachusetts now costs $12,000.
Reform advocates here say it's not clear if the Massachusetts experiment can succeed. But if it doesn't, other states like California with higher numbers of uninsured aren't likely to be able to do it either.
Richard Knox, NPR News, Boston.
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