Nearly every person in Massachusetts
will have health insurance by next
July, officials there
claimed recently, thanks to a plan that combines
government action with responsibilities for employers and individuals.
Maryland is toting its plan to force large employers to provide
insurance (actually, the law applies only to Wal-Mart), and the former
governor of Oregon
believes that his state should
abolish Medicaid and
Medicare, replacing them with a public health plan that all state
residents are eligible for.
State governments have always played a role in providing health
insurance. But experts say there is increasing energy coming from state
officials, largely because there is so little of it in Washington.
In New York State,
almost 3 million people lack health insurance -- six out of ten of those
live in New York City. The uninsured have less access to health care,
and, consequently, poorer health, than those with insurance. In
addition, the large uninsured population also places financial burden
on both the governments and private hospitals that serve them.
Unlike some places elsewhere in the country, New York State officials
are not hard at work on a magic bullet for universal health care
coverage. A bill is advancing through the legislature, however, that
would require large employers to insure their workers. The bill's
supporters are optimistic its chances, but they also acknowledge that
at best it is only a small piece in the puzzle. So as they develop
state policy here, officials and health experts have been watching more
ambitious plans elsewhere.
A PIECE IN THE PUZZLE?
Across the country, state legislators are considering bills that would
penalize employers who don't provide health insurance. Such a law
already exists in New York City. The law's scope is fairly limited, but
is currently in court because Mayor Michael Bloomberg has challenged
New York State's more ambitious attempt at an employer requirement is
Fair Share for Health Care bill. This bill would require all businesses with
more than 100 employees to pay $3 per hour per employee for health
insurance, an amount based on the estimate of how much it costs
actually to insure someone.
Supporters of the legislation argue that some large employers rely on
public health insurance programs for their employees, instead of
providing health insurance themselves. This is both a drain on
taxpayers and an unfair advantage over those employers who do provide
health insurance. Advocates for such laws nationwide say that the
momentum for employer requirements is already putting pressure on large
companies like Wal-Mart to reassess providing health insurance for
But critics say that it distorts the labor market. In other states
found loopholes, or have cut back on the amount of business they do,
argues Regina Herzlinger of the Heritage Foundation.
The legislature is planning hearings on the bill for May. Even if it
passes, though, its supporters say there will hardly be a reprieve.
This bill is intended to keep employers from exploiting Medicaid, said
Richard Gottfried, its primary sponsor in the assembly; it "is not
meant to be a solution to the uninsured."
A MODEL FOR UNIVERSAL HEALTH CARE?
Massachusetts became the center of attention in April when it announced
a plan that it claimed will provide
near-universal health coverage for its citizens by the middle of next year.
Everyone from the state's Republican governor to the New York Times'
editorial page heralded the plan as a possible model for other states.
Democratic gubernatorial candidate Eliot Spitzer recently indicated his
"great interest" in the plan, and Republican candidate William Weld
(himself once governor of Massachusetts) said it could be a "brilliant
Not everyone believes that the plan will work for Massachusetts. Even
if it does, say others, there is no guarantee it would work in New
York, which has a greater percentage of uninsured workers and a larger
population in general.
But there is no question the plan is being watched carefully.
"The project is both novel and ambitious," said Alex Navarro of the
Working Families Party, which is working on the Fair Share for Health
Care bill and is dubious of the potential of the Massachusetts plan.
"Those are qualities that get people's attention."
Massachusetts has patched together a mixture of action by individuals,
employers, and the state government to form its plan.
Everyone in Massachusetts must find a way to get health insurance by
July 1, 2007 â€“ supporters compare the requirement to the one that says
drivers must have auto insurance. Using information from tax returns,
the state will determine who does not have health insurance, and fine
The success of this approach will rely on whether people actually buy
insurance â€“ and that means helping those who have not been able afford
it in the past. The state will subsidize health insurance for those
whose incomes are less than triple the poverty rate. Massachusetts also
plans to expand Medicaid, the government health insurance program for
Employers who do not contribute to the health insurance costs of their
workers must pay a $295 annual fee for every employee.
The political success of this approach is that it has managed to be
things to all people. The government and business contributions appeal
to liberals; the stress on personal responsibility and consumer choice
Massachusetts citizens will have health insurance," wrote Massachusetts Governor Matt Romney in the
Wall Street Journal. "It's a goal Democrats and Republicans share, and
it has been achieved by a bipartisan effort."
But everyone didn't really agree on everything.
Romney toted the plan's "market reforms". But he called the portion
that required employers to contribute to health insurance "unnecessary
and probably counterproductive", and vetoed it. The legislature is
expected to override this move.
Meanwhile, critics questioned the market's ability to solve health care
problems. Unless there are enormous subsidies, they say, decent health
coverage will remain unaffordable for those with low incomes who don't
qualify for Medicaid. Some have also described the employer's role as
"It's hard to imagine that they're going to be able to provide high
quality care to everyone with the money they intend to spend," said
Mary O'Brien of the New York chapter of the Physicians for a National
Health Plan, a group that has referred to the plan as a "cruel hoax."
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