Hey, Boston hipster. You live in Allston-Brighton, you drink Pabst Blue Ribbon, and you’re political to the extent that you sometimes wear a “Don’t Tase me, bro” T-shirt.But the future of national health-care reform is playing out in Massachusetts, and the key players who will determine whether we have found the model for success are people like you: first-jobbers, slackers, and new-economy entrepreneurs, folks who seldom contemplate their role in shaping public policy, and who are usually ignored by those in charge.
Massachusetts is, of course, requiring every adult citizen to purchase health insurance by the end of 2007. This experiment is taking its bow as the idea of reforming the national health-care system has climbed in status to the top of the issue ladder. States across the nation are drafting their own plans, and presidential candidates are touting their solutions. Many of the ideas — including Governor Arnold Schwarzenegger’s in California, and Senator Hillary Clinton’s on the presidential-campaign trail — closely ape the innovative solution being imposed here, which was developed by, of all people, Mitt Romney. (He’s since issued confusing platform directives on his stance, but more on that later.)
Democrats and Republicans alike are now talking about moving forward with some kind of national reform. The Bay State experiment has “been an inspiration to the national debate,” says Judy Feder, dean of the non-partisan Public Policy Institute at Georgetown University. “Massachusetts going forward gave [health-care reform] a big boost.”
And the stakes are clear: if the system works well in Massachusetts, odds are that the nation will follow. If it fails here, this approach dies.
Popular mandate?
Massachusetts is the first place in the US — and only the third in the world — to mandate that every individual buy health insurance. That coverage mandate is key to the plan’s goal of spreading the risk and costs among all citizens. Already, presidential candidates Clinton and John Edwards have included the individual mandate in their own health-care proposals. California’s plan includes a mandate, too.
But national observers are far from convinced that the mandate is a practical solution. “Both John Edwards and Hillary Clinton are embracing a robust individual mandate, before it has been shown to actually work here,” says John McDonough, executive director of advocacy group Health Care For All, which fought for universal coverage in the state. “It is by no means settled that this will work in Massachusetts, let alone anywhere else.”
Some suggest that, while lower-income families will take advantage of newly available lower-cost insurance options, others will be harder to rope in. Namely, healthy, single, 25- to 35-year-olds, most of whom earn too much to qualify for subsidized rates, but little enough that health-insurance premiums — on top of rent, car insurance, and student loans — seem like an unaffordable luxury.
That cohort is the toughest group to bring into the insurance system, says Laura Trueman, executive director of the advocacy group Coalition for Affordable Health Coverage, in Washington, DC, whose members include physicians, insurance carriers, and consumer groups. “Many of them look at it and say, ‘The value for me is not there.’ ”
If Massachusetts finds that it takes a huge, expensive, time-consuming process to enroll this demographic and to keep them in the system, the individual mandate won’t look very practical, and will likely be avoided in future plans.
More important to local citizens, if the new system doesn’t function as intended, the state will be in a real jam: among other problems, Massachusetts could potentially lose hundreds of millions of dollars in federal grants that are predicated on increased enrollment. “If we fail in this, we are in a deep, deep hole as a Commonwealth,” says McDonough. “The price of failure is significantly higher than the price of success.”
Pay to play
Getting everyone in Massachusetts insured, experts say, is critical for three reasons. First, it’s best for the health of individuals. Second, it helps spread out the cost of the system among all residents, not just the ones who use health care most often. Third, when the uninsured do need medical care, they are often unable to pay, leaving providers and the state’s Uncompensated Care Pool to pick up the tab — a cost that the new system, by insuring everyone, should dramatically reduce.
The new Massachusetts plan tries to encourage more employers to offer health insurance to their workers, by decreasing costs and by imposing fees on those that do not. Meanwhile, the plan will make it easier and more affordable for individuals to get insurance on their own. To do that, the Commonwealth Health Insurance Connector, a special state-run body created to link people to plans, works out the packages and costs of coverage, as well as the subsidies available to lower-income residents.
