Expanded Health Care: Can the promise be realized?

Expanded Health Care in Massachusetts:

Can the promise be realized?

While meeting many of the long-held goals of health care advocates, Massachusetts' recently enacted health reform law has drawn dire predictions from a number of medical professionals, even while it has side-stepped the broader issue of a single payer plan.

Meanwhile, the legislative debate brought out an unprecedented lobbying effort, as vested interests battled to advance their agendas in the final language of the law. In 2005 alone, more than $7.5 million was spent on everything from splashy public relations to quiet Beacon Hill persuasion. Figures for 2006 are not publicly available but they are sure to add to the record spending. Health care lobbying has become big business in the Bay State.

The good news is that the law expands eligibility for children whose family income is up to 300 percent of the poverty level, and it reinstates dental and eyeglass benefits for adult MassHealth recipients. The law also subsidizes private insurance coverage for residents whose household income is up to 300 percent of the poverty level. And it imposes a financial penalty on employers with 11 or more workers who do not provide health insurance. Employers would be assessed a charge of up to $295 per full time employee, with contributions pro-rated for part time and temporary workers.

Some health professionals argue that the legislature has underestimated the cost of expanding coverage and predict that many of the promises of the new law will never be fully realized. Because the new law does little to control costs, they say, expenses will outrun tax revenues and coverage will be curtailed.

One of the many uncertainties is the bill's "individual mandate" provision which has been portrayed as imposing financial penalties on people above certain income levels who do not purchase health insurance. However, the actual language of the law is far less directive. People must have access to health plans that are both "comprehensive" and "affordable," as determined by a new state agency before any penalties would be instated.

(A thoughtful and detailed critique of the Massachusetts law has been prepared by the Boston-based health advocacy organization Community Catalyst and can be found at its web site: www.communitycatalyst.org.)

Massachusetts has expanded health coverage even as national studies show the percentage of uninsured has reached record levels. Americans, you might say, are dying for health insurance. Economist Paul Krugram, writing in the May 1, New York Times, cites a study from the National Academy of Sciences estimating that lack of health insurance leads to 18,000 unnecessary American deaths each year.

Yet, our inadequate system, Krugman writes, "actually costs more to run than we would spend if we guaranteed health insurance to everyone."

Our fragmented, privatized approach squanders more than 20 cents of every health premium dollar on outlays other than medical care, such as marketing, administration and insurance company profits. By comparison, Krugman notes, the single-payer system already in place for older Americans , Medicare, allocates "about 98 percent of its funds on actual medical care."

Here is Krugman's bottom line: Older Americans are already covered by a national health insurance system; extending that system to cover everyone would save money, reduce financial anxiety and save thousands of American lives each year."

Massachusetts has taken a step toward expanding coverage. The next order of business would be moving to a single payer system.