A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Today's NYT Editorial Gets It Right on MA Health Reform

Today's NYT Editorial Gets It Right on MA Health Reform

April 15, 2006

In the huge volume of writing on the MA health reform law, today's New York Times editorial gets it as well as anything else I've read:

The federal government has done such a miserable job of providing health insurance for the 46 million Americans who lack it that states around the country have been forced to step in with their own plans. The latest and boldest effort was signed into law this week in Massachusetts. It is a carefully crafted plan with elements that could serve as a model for elsewhere, provided Massachusetts finds sufficient funds to make it all work.

The cornerstone of the program is a requirement that everyone have a health insurance policy or pay a financial penalty. States have long required drivers to carry liability insurance, but this is the first time any state has imposed a health insurance mandate.

The move is already raising hackles among libertarians, who consider it an unwarranted government intrusion into decisions that should be personal. But the truth is, very few of the uninsured go entirely without medical care. When they get sick, they typically show up at emergency rooms, where they get very expensive care without paying.

By forcing all residents to assume responsibility for their own health coverage, Massachusetts should largely solve this "free rider" problem and tilt treatments back toward routine and preventive care and away from emergency care.

Of course, requiring people to get coverage doesn't mean much if they can't afford to buy it, so Massachusetts has come up with creative measures to make insurance accessible. There will be subsidies for low-income people. Insurers will be allowed to offer cheaper policies with fewer prescribed benefits for young adults. An innovative "connector" organization will serve as a marketplace where people can buy portable insurance with pretax dollars. Small employers can in essence designate the connector as their group health plan, easing their burden. The state's Medicaid enrollment will also be expanded.

The Massachusetts plan has unusually strong bipartisan support and includes elements drawn from both liberal and conservative playbooks. Although Mitt Romney, the Republican governor, has vetoed several elements of the plan, including a fee on businesses that refuse to participate, he is almost certain to be overridden by the overwhelmingly Democratic legislature.

Lots of details must still be worked out, and there are already concerns that the financial underpinnings of the plan are shaky. But Massachusetts deserves credit for tackling a problem that Washington is failing to address.