Guinea pigs

By DAVID S. BERNSTEIN  |  October 31, 2007

Some, including McDonough of Health Care For All, argue that the penalty should be lower during this start-up phase. McDonough says that a lower fine is under consideration. “We’ve been urging the Patrick administration to view 2008 as a phase-in year,” he says.

But those eager to extend the Massachusetts plan elsewhere want to hurry the process of pushing people to enroll, not delay it. With health-care reform such a hot topic on the campaign trail, there’s a good chance the president elected in November 2008 will enter office with a mandate to enact reform. McDonough knows that national observers want concrete results by then. “All the work we’re doing in Massachusetts,” he says, “is really preparatory for the national effort that will begin in June 2009.”

Federal help
That mandate won’t be there, however, if voters elect the man who led the charge to enact the Massachusetts system. As much of the fate of the country’s health care weighs on the Massachusetts experiment, it weighs particularly heavily on its chief architect: former governor Mitt Romney.

Romney, now seeking the Republican Party’s presidential nomination, can’t seem to decide how he feels about the plan he spawned.

When he signed the health-care reform package into law, in late 2006, many expected it to be the signature bragging point of Romney’s four otherwise lackluster years running the state. But when conservative think tanks found fault with his approach, Romney seemed to drop it like his old pro-choice position.

Romney’s current proposal disavows the individual mandate, which many conservative Republicans view as intrusive governmental interference. He has even derided the Edwards and Clinton plans as something out of the communist Soviet Union playbook.

Later in the campaign, however, Romney again started taking credit for the Massachusetts plan — or parts of it, anyway — in an attempt to distinguish between what he calls Massachusetts’s “market-driven” approach and Clinton’s nearly identical plan, which Romney calls “government-driven.”

So, if the Massachusetts plan works smoothly, is that good news for Romney, who spawned it, or bad news since it clashes with what he now claims to support?

Regardless of the presidential politics involved, some Washington observers believe that any federal health-care-reform bill would leave the issue of individual mandates to the states. But the federal government could give states, including Massachusetts, a better shot at making their mandates work.

One way the federal government could help is now under consideration in congressional committees, and involves the federal tax code. It would extend to individual insurance purchasers the tax break currently enjoyed by those insured through their employers. Members of employee plans are not taxed on the income used to pay for health insurance. The same is not true for those buying insurance on their own.

Providing that federal tax break would make health insurance more affordable for those now being hit by the individual mandate in Massachusetts. In the meantime, Massachusetts has done what it can to bring down the cost of insurance, subsidizing the cost through two main sources: fines on businesses that don’t provide insurance to employees, and savings from the Uncompensated Care Pool, which should be used less as more state residents become insured.

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