The Massachusetts health care reform policy was proposed by Massachusetts Governor Mitt Romney and enacted in 2006. It states that every Massachusetts resident must obtain health insurance. The law also provides that Massachusetts residents who earn up to 100% of Federal Poverty Level (FPL) are given subsidized health care, while those who earn up to 300% get partial subsidy health care. This is calibrated on an income based sliding scale and must be applied to all Massachusetts residents.
As the Commonwealth Health Care Connector director Mr. Jon Kingsdale said, Massachusetts has attempted to become a test laboratory that would give results expected to be emulated by the rest of the country. As a result, the approach is to be very flexible as institutionalization of the policy is implemented. Moreover, Massachusetts has been accorded credit by many for what Washington has failed to address, Massachusetts has tackled (Bloche, 2003, p. 16).
The policy is a free-market’s system that aims at every person’s health coverage though some critics don’t view it as a universal coverage per say as their opinion is that the government aims at overruling fundamental individual rights by adopting a mandatory scheme for all. As Romney suggested, the policy intends to make every uninsured citizen to acquire affordable insurance as opposed to previous conditions where only the financially sound persons could get health insurance cover.
This therefore implied finding ways of reducing health insurance costs through processes of encouraging what Romney calls “personal responsibility” and “market reformations”. In addition, the policy would neither require introduction of new taxes nor governmental takeover. From these and other such appealing connotations, the plan gained continued support from individuals and organizations including California’s Governor Arnold Schwarzenegger, Democratic Senator Kennedy Ted, Health Care for all, Conservative Heritage Foundation, among many others (Mirriam, 1994, p. 23).
The Massachusetts plan was partially conceived as a response to the current health care costs, which have been increasing at a rate twice as much as that of inflation. This has been making health insurance progressively unaffordable by many individuals and employers as well. By the time the policy was being introduced, there was an approximate 47 million American population that didn’t have a health insurance cover. The State of Massachusetts legislature led by Governor Romney therefore came up with this idea that would guarantee all Massachusetts residents’ health care at a reduced cost.
There are some elements that were included in the Massachusetts plan. The state established a Commonwealth Health Insurance Connector hereafter referred to as the Connector and which is a quasi-governmental governing authority. This is the clearinghouse and it is through it that individuals purchase insurance plans after they have been approved by the government. All individuals are expected to purchase an insurance policy. They can either buy through the Connector or from private insurers and those who do not comply are to be subjected to financial penalties which are relatively very stiff.
Depending on individual income levels, those who cannot afford are to be subsidized in full or in part. Any employer who employs more than ten employees is required to provide his/her employees with health insurance or alternatively, pay a special fee that will cater for low-income employees’ subsidized coverage. This theory therefore lowers the average individual person’s insurance cost by increasing the number of insured persons.
it also means that healthier, younger individuals , particularly those who opt not to buy the insurance cover, are required to comply and as result pay to the larger population a part of the health costs involved (Colleen, 2000, p. 19). Attractiveness of this plan to the liberals is particularly due to the fact that it is supposedly going to ensure universal coverage. Furthermore, they assume that it won’t require them to support the socialized “single payer” Canadian-style medicine which is presumably more politically risky.
The conservatives were for this plan since to them it supposedly encourages personal responsibility and at the same time it preserves market framework for everyone’s health insurance. It seems that law makers in Massachusetts easily enacted this measure through a grand collective compromise among all the stakeholders including the government, individuals, and employees. Just a few years after its inception, everyone seems to be realizing that it is easy to talk of the mandatory health insurance than to actually actualize it.
The state has been funding millions of dollars from it Medicaid program to pay clinics and hospitals for the uninsured each year (Morone, 1994, p. 30). Without considering other excruciating costs involved, it has proved quite difficult to implement a mandatory insurance coverage. This is especially in instances when some of the people feel that they do not need it. Some statistics show that of all the Massachusetts uninsured individuals, about 400,000 are single males.
Research has also indicated that health insurance is perceived as a necessity to sissies and not for the young men (as Mr.Kingsdale once said). From the fact that generally young males are healthy, the policy looks attractive in the sense that the average overall coverage cost will most likely reduce if these young men are pooled with other insured persons. This is precisely so because this population is not expected to require very expensive medical treatment. This culminates to achieve the plan whose main objective is generation of a market in which affordable and attractive coverage is offered by insurers to entice young males as well as those who could not otherwise have afforded it.
The fine that is imposed by the law for defilers of this policy is $219 for the first year that proof of coverage is not shown and in 2008, up to half of the premiums’ cost (based on the least expensive premium). This brings in the dilemma of affordability in which about 20% of the population is expected to be exempted from the program. This is considering that there is a substantial population that cannot afford it but they are categorically not too poor to acquire subsidized or free coverage.
This predicts that almost one fifth of the uninsured in the state will automatically be exempted from this law and as such this desired universal coverage will remain a very elusive objective to achieve (Porter, Teisberg, 2006, p. 337). The Massachusetts plan is welcome by many because some surveys have shown that a large portion of the United States’ population relies on government programs or their employers for coverage. In addition, those individuals who seek insurance cover on their own usually face very difficult and sometimes impossible hurdles in the task.
Some of these reports indicate that only one out of ten people who wanted to buy a health insurance actually buys one and the rest abandons the idea due to the difficulties involved. Some say that the cover they desired is denied them while others think they could not find any policy they expected to afford (Bloche, 2003, p. 28). This means that favorable measures must be put in place to ensure that all categories of people are keenly evaluated. One such measure was merging small groups and individual insurance markets to lower the costs as well as asking insurers to review their bids so as to propose lower premiums.
A result of this includes some insurers offering policies as low as $100 dollars a month to appeal to young people within a 19-26 years range. Before enacting the law, 37 years old Bostonian was, for example, expected to pay $335 dollars per month, and this figure didn’t cover for prescription in addition to being $5000 deductible per year. After the policy was implemented, the same person can now comfortably buy a plan that includes drug prescription for only $175 per month and an annual deductible of $2000.
The uncertainty persists on whether it will be possible for Massachusetts to sustain the program and find consistent sources of funds for free and subsidized insurance coverage. Insurers are also speculative as to whether they will afford to survive with these low premiums they are currently offering. Moreover, those states with fewer resources and more uninsured residents are expected to experience aggravated problems in finding sources of funds for similar plans in future.
The bottom line of this is that Massachusetts and any other state must evaluate the cost-effectiveness of this policy before individual mandate is made as compulsory common place like is the case in the auto insurance. The evaluation must ascertain that the policy is able to significantly reduce the uninsured people’s number at relatively acceptable costs (Porter, Teisberg, 2006, p. 338). References Bloche Gregg (2003). The Privatization of Health Care Reform: Legal and Regulatory Perspectives.
Oxford: Oxford University Press, pp. 16, 28 Colleen Flood (2000). International Health Care Reform: A Legal, Economic, and Political Analysis. London: Routledge, pp. 19 Miriam Ostow (1994). The Road to Reform: The Future of Health Care in America. New York: Free Press, 23 Morone James (1994). The Politics of Health Care Reform: Lessons from the Past, Prospects for the Future. New York: Duke University Press, pp. 30 Porter Michael & Teisberg Elizabeth (2006) Redefining Health Care: Creating Value- Based Competition on Results. New York: Harvard Business Press, pp. 337, 338