Marcia Angell
Health Reform You Shouldn't Believe In: What the Massachusetts experiment teaches us about incremental efforts to increase coverage by expanding private insurance.
The American Prospect
April 21, 2008

For all their promise of change, Democrats are remarkably timid about changing the health-care system. The system now costs twice as much per person as those of other advanced countries and delivers worse average outcomes. It prices tens of millions of people out of health coverage altogether and limits care for countless others. Yet leading Democrats are clinging to this system, proposing to cover more people but not changing the system itself except at the margins. The timidity extends to choice of words. No one is supposed to say "single-payer" or "national health insurance" anymore, because that is "politically unrealistic"; the most we are allowed is to talk of reforming the system incrementally so that someday it will morph into "Medicare for all."

Thus, the proposals for reform taken most seriously by Democrats -- including Barack Obama and Hillary Clinton -- would retain the central role of the investor-owned private insurance industry as well as the thousands of for-profit businesses it pays to deliver medical services. This is the industry, mind you, that has brought us to the predicament we're in now, so let's take a quick look at it.

The U.S. health system is unique in treating health care as a commodity to be bought and sold in a marketplace. Care is distributed according to the ability to pay, not according to medical need. Private insurers compete by avoiding high-risk individuals, limiting services for those they do cover, and, whenever possible, shifting costs to other payers or to patients in the form of high deductibles and co-payments. We have the only health system in the world based on avoiding sick people. It's a chaotic and fragmented system that requires mountains of paperwork, which is one reason premiums are so high. Employers who offer health benefits react by capping their contributions, so that workers pay more out of pocket and bear the full brunt of premium increases.

Insurers contract with hospitals, HMOs, and other health facilities to provide the care. They, too, are often for-profit businesses that promote lucrative services for well-insured patients (such as coronary catheterization for Medicare recipients), while giving short shrift to less profitable ones (such as psychiatric services for the indigent). To compete in a market environment, even not-for-profit facilities behave in much the same way as for-profit ones. Doctors often act as entrepreneurs, investing in health facilities to which they refer patients. And because they are usually paid on a fee-for-service basis, they have a strong incentive to overuse tests and procedures that have the greatest profit margins.

All of this drives up costs to the overall system, while yielding profits for the various players within it. In fact, there's a fundamental illogic to trying to contain costs in a market-based system. Markets are about expanding, not contracting. Like all businesses, hospitals want more, not fewer customers -- but only as long as they can pay. Conventional wisdom holds that we need to retain this system because many Americans are satisfied with it. But except for industry spokespeople and politicians whose campaigns they support, I've never met anyone who actually is. Many people like their doctors, but that is not the same as liking the system.

The reforms favored by leading Democrats vary somewhat, but all have at their heart expanding insurance coverage through public subsidies for those who can't afford the premiums or, alternatively, permitting those without access to good, affordable insurance to enroll in a new Medicare-type program that would be set up to provide them with coverage. Some reform proposals include a mandate requiring everyone to be insured.

Many proponents hope that a parallel Medicare-like system would eventually crowd out its less efficient private competitors, that under a play-or-pay requirement, employers would gradually decide to stop providing coverage and just pay into the common pool. However, this wishful thinking overlooks the power of the private health industry, through its huge lobby, to influence the rules so that it continues to profit while the public system is undermined.

All of these variations in the Democrats' plans run into this intractable dilemma: If the system stays essentially as it is and we try to expand coverage, costs will inevitably rise. On the other hand, attempts to control costs will inevitably reduce coverage. Without fundamental reform, coverage and costs have to move in the same direction. Yet, we don't have the option of expanding both coverage and costs. At 16 percent of gross domestic product, our health-care system is already unaffordable. In fact, costs are the central problem; universal health care would be easy if money were no object. Furthermore, none of the proposed reforms offers any workable mechanism for controlling the unsustainable inflation in health costs. Attempts to regulate private insurers to prevent the worst abuses would probably do little more than add to the complexity and administrative costs of the system.

The proposed reforms also make the fundamental mistake of confusing insurance with health care. As many Americans are learning, the two are not the same -- not by a long shot. Health insurance can easily be too skimpy or too laden with exceptions and co-charges to be of much use. What people really want when they're sick is medical care, not medical insurance, just as they want education for their children, not the opportunity to buy education insurance.

Despite the Democrats' coalescence around the same approach for achieving universal care, only one such plan has been implemented -- the Massachusetts health-reform plan. It is therefore worth looking at in some detail.

MASSACHUSETTS MIRACLE OR MIRAGE?

This plan, which was enacted in April 2006 amid extraordinary hoopla, set out to cover the 500,000 to 750,000 uninsured residents of the state, and to see that the coverage for everyone else met a minimum standard. To that end, the state would purchase insurance for everyone with incomes beneath the federal poverty level, and partially subsidize it for those earning up to three times the poverty level (which now comes to $31,200 per year for an individual). Everyone else -- roughly 200,000 to 250,000 people -- would have to purchase his or her own insurance or face stiff fines. The legislation established a new state agency, the Commonwealth Health Insurance Connector, which would try to make sure insurance was affordable and met the minimum standard and which would also determine the level of subsidies.

Financing the plan was iffy from the outset. When fully implemented, it was projected to cost the state only $125 million in new money the first year -- not very much in a state with a $26 billion budget. Mostly it would be financed by diverting existing funds from two sources: Medicaid, under a two-year waiver that would permit federal money to be used for this purpose, and the state's generous "free care pool," which was established to provide direct services to uninsured patients in safety-net facilities and is supported by assessments on hospitals and insurers. There would also be a paltry fine on employers who didn't offer insurance, but no one thought that would be an important source of funding. Success would depend crucially on the individual mandate requiring those with incomes more than three times the poverty level to pay for their own insurance.

What's happened since then? While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll. The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because -- yes, that's right -- they couldn't afford it (so much for universality). The state modified its requirement that all insurance meet a minimum standard. Jon Kingsdale, the executive director of the Commonwealth Health Insurance Connector, told me that was because the federal Employee Retirement Income Security Act prohibits states from setting standards when employers act as their own insurers (didn't the Massachusetts legislators know that when they crafted the law?), but he said that next year workers will be responsible for somehow upgrading their own policies, or (you guessed it) be fined.

Don't get me wrong. Massachusetts is to be congratulated for seeking to extend health care to everyone in the state. Every decent society should ensure health care, just as it does education, clean water, and police and fire protection. Massachusetts' plan is an ambitious and well-intentioned effort. But unfortunately, it's extremely unlikely to work for three main reasons.

First, the individual mandate is harsh, regressive, and probably unenforceable. It requires the near-poor to pay a much higher percentage of their income on health care than their more affluent neighbors. Although insurers are prohibited from charging more for people with medical conditions, older people have to pay more. The premiums for a 57-year-old are twice as much as for a 27-year-old. According to the Connector's Web site in March of this year, the least expensive plan for a 57-year-old had a premium of $4,700 per year, a $2,000 deductible, and substantial co-pays and co-insurance up to $4,000 per year. (That cap did not include prescription drugs.) So a hypothetical 57-year-old with a $32,000 annual income (just over three times the poverty level) could pay as much as $8,700 out of pocket -- or over a quarter of his income. Family plans are, of course, different, but the effect is the same. Next year, those who haven't purchased insurance will be fined half the premium of the lowest-priced plan. Truly this is the Squeeze Blood from a Turnip Plan.

This plan, which was enacted in April 2006 amid extraordinary hoopla, set out to cover the 500,000 to 750,000 uninsured residents of the state, and to see that the coverage for everyone else met a minimum standard. To that end, the state would purchase insurance for everyone with incomes beneath the federal poverty level, and partially subsidize it for those earning up to three times the poverty level (which now comes to $31,200 per year for an individual). Everyone else -- roughly 200,000 to 250,000 people -- would have to purchase his or her own insurance or face stiff fines. The legislation established a new state agency, the Commonwealth Health Insurance Connector, which would try to make sure insurance was affordable and met the minimum standard and which would also determine the level of subsidies.

Financing the plan was iffy from the outset. When fully implemented, it was projected to cost the state only $125 million in new money the first year -- not very much in a state with a $26 billion budget. Mostly it would be financed by diverting existing funds from two sources: Medicaid, under a two-year waiver that would permit federal money to be used for this purpose, and the state's generous "free care pool," which was established to provide direct services to uninsured patients in safety-net facilities and is supported by assessments on hospitals and insurers. There would also be a paltry fine on employers who didn't offer insurance, but no one thought that would be an important source of funding. Success would depend crucially on the individual mandate requiring those with incomes more than three times the poverty level to pay for their own insurance.

What's happened since then? While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll. The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because -- yes, that's right -- they couldn't afford it (so much for universality). The state modified its requirement that all insurance meet a minimum standard. Jon Kingsdale, the executive director of the Commonwealth Health Insurance Connector, told me that was because the federal Employee Retirement Income Security Act prohibits states from setting standards when employers act as their own insurers (didn't the Massachusetts legislators know that when they crafted the law?), but he said that next year workers will be responsible for somehow upgrading their own policies, or (you guessed it) be fined.

Don't get me wrong. Massachusetts is to be congratulated for seeking to extend health care to everyone in the state. Every decent society should ensure health care, just as it does education, clean water, and police and fire protection. Massachusetts' plan is an ambitious and well-intentioned effort. But unfortunately, it's extremely unlikely to work for three main reasons.

First, the individual mandate is harsh, regressive, and probably unenforceable. It requires the near-poor to pay a much higher percentage of their income on health care than their more affluent neighbors. Although insurers are prohibited from charging more for people with medical conditions, older people have to pay more. The premiums for a 57-year-old are twice as much as for a 27-year-old. According to the Connector's Web site in March of this year, the least expensive plan for a 57-year-old had a premium of $4,700 per year, a $2,000 deductible, and substantial co-pays and co-insurance up to $4,000 per year. (That cap did not include prescription drugs.) So a hypothetical 57-year-old with a $32,000 annual income (just over three times the poverty level) could pay as much as $8,700 out of pocket -- or over a quarter of his income. Family plans are, of course, different, but the effect is the same. Next year, those who haven't purchased insurance will be fined half the premium of the lowest-priced plan. Truly this is the Squeeze Blood from a Turnip Plan.

The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition. There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top. Employers, too, would no longer be involved in health care. Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses.

This is not the same as Medicare for all. Medicare is embedded in our market-based entrepreneurial private system, and therefore experiences many of the same inflationary forces, including having to deal with profit-maximizing hospitals and physicians' groups. Doctors' fees are skewed to reward highly paid specialists for doing as many expensive tests and procedures as possible. As a result, Medicare inflation is almost as high as inflation in the private sector and similarly unsustainable.

In addition, Medicare is not what it once was. For the past eight years, it has been at the mercy of an administration intent on dismantling and privatizing it. The prescription-drug benefit enacted in 2003 is an example. It's a bonanza for the pharmaceutical industry because it forbids Medicare from using its purchasing power to get good prices. Medicare recipients have also been encouraged to enroll in private health plans, which are paid on average 12 percent more than it would cost traditional Medicare to care for the same people. Even as public funds are siphoned off to the private sector, premiums and co-payments have been increased, and there are now proposals for means testing -- a superficially attractive idea but ultimately a grave threat to any public program.

Over the years there have been many independent analyses of the costs of converting to a single-payer system, either within a state or nationally. They include studies by the General Accounting Office, the Congressional Budget Office, and consulting firms, such as the Lewin group, hired by state governments and, in Massachusetts, the state medical society. Most found that a single-payer system would initially cost roughly the same as the system it replaced, while providing universal coverage, and over time would be much cheaper.

Polls have shown that most people, and most Massachusetts doctors, favor a single-payer system. The Boston Globe called for a national single-payer system last May. In an editorial about the big three automakers' desire to transfer health costs to the autoworkers' union, the Globe said, "It would make more sense for the federal government to oversee a national health system financed from taxes. The cost could be spread across the entire population, rather than borne by Chrysler or other companies that no longer enjoy the assured profitability of their best years."

Nevertheless, the private insurance industry has managed to convince many political leaders, including progressives, that a single-payer system is unrealistic. But what is truly unrealistic is anything else. My greatest concern about the Massachusetts plan is that when it unravels, people will draw the wrong lesson. They will assume that universal care at a cost we can afford is impossible, and give up on it. It's not impossible; it's just unlikely to be achievable while leaving our dysfunctional system in place. Can we make it right? I'm tempted to say, "Yes, we can."

Marcia Angell, M.D. is a senior lecturer on social medicine at the Harvard Medical School and former editor-in-chief of The New England Journal of Medicine.

 

Steffie Woolhandler and David U. Himmelstein
Health Reform Failure
The Boston Globe
September 17, 2007
 
In 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage. Now, according to the Census Bureau’s latest figures, we’re back where we started, with 47 million uninsured in 2006 - up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.
 
The middle class is being priced out of healthcare. Virtually all of this year’s increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.
 
The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone - 43.9 percent of phoneless adults are uninsured, according to other studies.
 
It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn’t Spanish (e.g. Portuguese, Chinese, or Haitian-Creole), another group with a high uninsurance rate. In contrast, the Census Bureau goes door-to-door for its survey and has translators for almost every language. It gets a more complete picture.
 
In sum, Massachusetts health reform planners have been wishing away a quarter of a million uninsured people. Recent Patrick administration claims that health reform is succeeding are based on cooked books. According to the state’s figures, almost half of the previously uninsured gained coverage under the health reform bill by July 1. But according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured. Moreover, it’s likely that much of that gain has already been wiped out by shrinking job-based coverage - a longstanding and nationwide trend.
 
Why has progress been so meager? Because most of the promised new coverage is of the “buy it yourself” variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments remain a barrier for many in this near-poor group.
 
And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don’t buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.
 
While the middle class sinks, the health reform law has buoyed our state’s wealthiest health institutions. Hospitals like Massachusetts General are reporting record profits and enjoying rate increases tucked into the reform package. Blue Cross and other insurers that lobbied hard for the law stand to gain billions from the reform, which shrinks their contribution to the state’s free care pool and will force hundreds of thousands to purchase their defective products. Meanwhile, new rules for the free care pool will drastically cut funding for the hundreds of thousands who remain uninsured, and for the safety-net hospitals and clinics that care for them. (Disclosure - we’ve practiced for the past 25 years at a public hospital that is currently undergoing massive budget cuts.)
 
Health reform built on private insurance isn’t working and can’t work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare’s and 11 times those in Canada’s single payer system. Single payer reform could save $7.7 billion annually on paperwork and insurance profits in Massachusetts, enough to cover all of the uninsured and to upgrade coverage for the rest of us.
 
Of course, single payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health reform to get beyond square one.
 
Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program and are primary care doctors at Cambridge Hospital.

Health care plan may not be a good fit—But the Massachusetts insurance mandate stirs interest in California.
By Aurelio Rojas -- Bee Capitol Bureau
August 6, 2006

Ever since Massachusetts became the first state to require residents to carry health insurance -- a concept that intrigues Gov. Arnold Schwarzenegger -- questions have been raised about the feasibility of such a law in California.
The Massachusetts plan, which also requires businesses to contribute to employee coverage, was "the centerpiece of discussions" at a meeting of state officials last week in Chicago, said Kim Belshé, Schwarzenegger's secretary for Health and Human Services.

"It's getting a lot of attention, and I think deservedly so, because at least one state has somehow figured out how to pull together a variety of different elements and, taken together, achieved close to universal coverage," said Belshé, who attended the Chicago meeting.

But John McDonough, whose advocacy group Health Care for All was instrumental in crafting the Massachusetts legislation, said the same market conditions do not exist in California.

The insurance industry is much more regulated in Massachusetts than in California. A Massachusetts patient, for example, cannot be turned down or charged more for insurance because of a pre-existing condition, such as diabetes or asthma. The state also has existing regulation of deductibles and co-payments.

"If you're in a state that doesn't have these kind of protections, you have no business talking about individual mandates," McDonough, a former Democratic legislator, said last week during a presentation in Sacramento sponsored by the New America Foundation.

Under the Massachusetts law signed in April by Republican Gov. Mitt Romney, the state will offer free or heavily subsidized coverage to poor and lower-income residents. Those who can afford insurance but refuse to purchase it will face up to $1,000 in fines a year.

While Massachusetts is dominated largely by a handful of nonprofit health insurers, California has a mix of for-profit and nonprofit insurers.

"No two states are alike," Belshé said, adding that California still can learn from Massachusetts. "What you need to do -- what we're doing and other states are doing -- is to look at components or a particular state strategy."

The scope of the insurance problem is also almost twice as great in California, where about 6.3 million people -- or one in five residents -- lack coverage , compared with one in 10 in Massachusetts.

Massachusetts also spends much more on uninsured people than California does.

McDonough said the biggest catalyst for the Massachusetts plan was the potential loss of a Medicaid waiver worth hundreds of millions of dollars, which continues to be the backbone of the program's funding.

Employers and insurers in Massachusetts already were required to pay into a pool to provide coverage for uninsured residents who use hospital emergency rooms.

"Frankly, our health system is starting to look like Switzerland and the Netherlands," McDonough said. "I mean, we're leaving North America.

A far lower percentage of Californians get insurance through employers than in Massachusetts. Efforts to mandate employer coverage in California were dealt a blow two years ago when voters repealed Senate Bill 2. Schwarzenegger supported the repeal, warning the state's economy was too fragile to impose another mandate on employers.
But the Republican governor expressed some interest in requiring residents to purchase health insurance, a mandate he likens to auto insurance.

If re-elected, Schwarzenegger told The Bee editorial board last month, he wants to focus next year on providing health care for the state's uninsured residents."I want to have that ready for my State of the State address and really challenge the legislators to work together to solve this," the governor said.

State Treasurer Phil Angelides, the Democratic nominee for governor, has chided Schwarzenegger for failing to come up with a solution during his three years in office. If elected governor, Angelides said he will work to pass legislation covering all children and requiring large employers to provide insurance.

The cost of Massachusetts program is estimated at $316 million in the first year, rising to more than $1 billion in the third year, with much of that money coming from federal reimbursements and existing state spending. Adopting a similar plan in California would be much more costly to state taxpayers -- perhaps as much $9.4 billion a year -- because California has a much larger number of uninsured poor residents, according to the California Health Care Foundation.

Belshé said Schwarzenegger is committed to health care reform, "but you cannot talk about expanding health coverage without talking about making progress on affordability and cost containment." Last month, the governor held a summit of health care experts in Los  Angeles, where the Massachusetts plan was a popular subject. At the governor's request, Belshé said the administration has been requesting and receiving additional written information from participants. "The governor has been very clear that he wants to come forward in January with very specific strategies for how California can make progress," Belshé said.

One Size Doesn't Fit All in Debate Over Healthcare
The large number of uninsured may keep California from adopting Massachusetts' ambitious model for universal coverage.

By Michelle Keller and Rong-Gong Lin II
Times Staff Writers. The Los Angeles Times. May 8, 2006

A Massachusetts law hailed as a national model for providing near-universal healthcare to uninsured residents would be difficult to duplicate in California because of high costs and the vast number of the Golden State's uninsured.

In California, with an estimated 6.5 million uninsured residents, a similar program could cost $9.4 billion, according to a report by the California Healthcare Foundation.

"However you feel about its feasibility in Massachusetts, it won't come cheaply in California," said Mark D. Smith, foundation president. "If you're having a rational debate about this issue, you cannot proceed with the illusion that it's going to be free."

With much fanfare, Massachusetts Gov. Mitt Romney last month signed a bill that created the nation's most comprehensive healthcare reform plan. The law targets low-income residents without insurance and those who can afford coverage but have none.

Effective July 1, 2007, the plan will require all residents to obtain health insurance or face possible tax penalties.

A state-authorized pool will be created to help connect insurers with individuals whose employers do not offer health benefits; low-income residents will be eligible for government--subsidized discount plans and, in some cases, free coverage.

The program will be mostly paid for with existing state money, federal matching funds and $125 million from the state's General Fund.

The landmark health reform bill was immediately hailed as a possible national model.

But Massachusetts, with a population of 6.3 million, enjoys a number of economic and demographic characteristics that would make its plan difficult to duplicate in such a large and diverse state as California with 37 million people.

Some key differences:

•  California has roughly 6.5 million uninsured residents, compared with Massachusetts' 600,000, thus a much larger share of the population would require financial assistance.

•  California's employers are less likely to offer healthcare coverage. In 2003, the state's legislature passed an employer mandate to provide health coverage that was overturned in a ballot initiative the following year.

•  Massachusetts will draw on a special $1-billion pool already dedicated to covering healthcare costs for the uninsured. The pool is financed through a variety of sources, including healthcare taxes, federal matching funds, tobacco settlement dollars and other state money.

California has no comparable fund to allocate specifically for the uninsured.

Despite such advantages, some question whether Massachusetts can sustain its plan, given the ever-rising cost of healthcare services, the difficulty of managing affordable coverage and the precariousness of federal subsidy programs.

Even if California chose to follow Massachusetts' example, healthcare experts said, it would have to consider several major changes.

One option would be to require employers who don't offer health insurance to pay more into the system, said Lucien Wulsin, director of the Santa Monica-based Insure the Uninsured Project.

That could prove politically difficult, however. The Massachusetts Legislature approved a provision that required employers without health plans to pay an annual $295 fee per employee.

Romney vetoed the provision, but legislators have vowed to override it.

Another option for California would be to require only that individuals buy a cheaper, bare-bones insurance plan, rather than the comprehensive plan Massachusetts requires.

"You need a hunk of money to subsidize [such a policy]," said Robert Blendon, professor of health policy and management at Harvard University. "The larger the policy you require, the larger the subsidy that the state would have to find from somewhere to make it feasible for people to buy."

Blendon suggested states could start by requiring minimal catastrophic insurance for most individuals, ensuring coverage for major medical expenses.

But a similar plan, proposed by California Assemblyman Keith Richman (R-Northridge), was defeated last month in committee.

Also last month, the Assembly's health committee passed a bill that would force employers without insurance to pay 75% of the cost of a worker's healthcare to the state. But the bill received no Republican votes, essential for its passage.

"It would just kill small businesses," said Scott Hauge, president of Small Business California, a bipartisan advocacy group.

The reason the Massachusetts mandate was able to garner support from both parties is because it spreads healthcare cost among individuals, government and employers, experts said.

"The burden can't fall on any one group," said Howard Kahn, chief executive of LA Care Health Plan, a Los Angeles-based health maintenance organization. "You have to bring the different groups together, including employers and health plans."

But some officials said Sacramento is in no mood for broad healthcare reform in the midst of a gubernatorial election year.

"The real problem has been the lack of political will to address the problem," said Assemblyman Richman.

"Our legislature is dysfunctional, and it has been in partisan gridlock."

California has seen three failed attempts over the past 14 years to implement a comprehensive healthcare package.

Yet advocates expressed optimism that Massachusetts' plan will spark greater debate in California about the idea of the "individual mandate," which some see as the key to forcing those who can afford to buy insurance to do so.

"We're not going to get a handle on healthcare coverage," said Robert Hertzka, former president of the California Medical Association, "until everyone who can is making a real contribution to the cost of their healthcare."

A tale of two states

Differences between Massachusetts and California may make it challenging to implement similar health insurance reforms. 

	California	Massachusetts
Population under 65	31,860,000	5,162,000
Per capita income	$24,420	$28,509
Percent who are uninsured	21%	13%
Insured with employer-based healthcare	57%	71%
Insured with Medicaid/Medi-Cal or Healthy Families	14%	11%
Percent of private companies that offer health insurance	56%	66%

Sources: UCLA Center for Health Policy Research, U.S. Census Bureau, American Community Survey Profile, 2003. Graphics reporting by Michelle Keller

 

High cost for health insurance : Massachusetts plan would run billions more in California
Victoria Colliver, San Francisco Chronicle
Thursday, April 27, 2006

Providing health insurance for all Californians under a plan similar to what Massachusetts recently adopted would cost about $9.4 billion more in this state, according to a study to be released today.

Massachusetts, earlier this month, became the first state to require individuals to carry health insurance or face financial penalties. The state doesn't expect much new public funding will be needed because it plans to redirect money spent on uncompensated care toward helping low-income people buy insurance.

An analysis by the Institute for Health Policy Solutions found a similar program would cost $9.4 billion more in California, or $1,450 per uninsured resident.

Socioeconomic and demographic differences between the states account for the disparity, the study found. "Our baseline of uninsurance is very different and our labor market is very different," said Dr. Mark Smith, president and chief executive officer of the California HealthCare Foundation, an Oakland health care philanthropy that commissioned the study.

For one, the percentage of people without health coverage is considerably higher in California than in Massachusetts. Nearly 20 percent of Californians lack coverage compared with about 13 percent in Massachusetts.

Employer-paid coverage is also offered more widely in Massachusetts than in this state, partly because California has more low-wage earners. Companies that hire workers at low wage levels are less likely to offer health insurance than other employers.

Meanwhile, Massachusetts spends far more public funds on uncompensated or "charity" care -- between four and six times more per uninsured person, the study found. Massachusetts' spending amounts to between $1,300 and $1,800 per uninsured person, compared with about $300 in California.

Smith said the Massachusetts law has brought the controversial debate over mandated insurance to the national level, but he questioned Massachusetts' cost estimates and noted the program has not gone into effect.

"All of the numbers are quite imprecise and speculative," Smith said. Massachusetts officials "can tell you exactly what the penalties are, but they can't tell you how much the insurance will cost and what it will cover."

Under the law, individuals who can afford to but fail to carry health insurance by July 2007 will face tax penalties. A provision that assessed employers who did not provide health insurance $295 per worker was vetoed by the governor, but Democratic Massachusetts lawmakers have vowed to override the veto.

Supporters of the Massachusetts law acknowledged it's not a one-size-fits-all-states program.

"People should look at what we did in Massachusetts more as a political blueprint and less as a policy blueprint," said John McDonough, executive director of Heath Care for All, a Boston advocacy organization that played a key role in shaping the legislation. McDonough, who had not seen the study, said the cost estimates for California sounded right.

In California, several efforts to expand coverage by promoting universal or mandated insurance are under way.

San Francisco Mayor Gavin Newsom has proposed a plan to expand health care to the city's uninsured by using government funds, employer contributions and other funds. Sen. Sheila Kuehl, D-Santa Monica, has proposed a bill supporting a state-run, single-payer system.

Considered the closest in spirit to the Massachusetts law is a bill authored by Assemblyman Joe Nation, D-San Rafael, which would enact both an employer and individual mandate for coverage. The bill, which differs in its funding mechanisms, passed through an Assembly committee earlier this week.

Nation said he believes Massachusetts has underestimated, the cost of providing coverage but he said the law has helped his efforts.

Regardless of the fate of the Massachusetts system, he said, "It's useful we are having discussion. ...There are too many people who think that health care should be free. Somebody's got to pay for it."

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

April 5, 2006
Massachusetts Sets Health Plan for Nearly All
By PAM BELLUCK

BOSTON, April 4 — Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign.
The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government.
"This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."
The bill, the product of months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007.
Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year.
All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected.
"It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."
Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed.
In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance.
The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.
Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system.
The Massachusetts bill was hammered out with proposals and input from state Democratic legislators; Mr. Romney, a Republican; Senator Edward M. Kennedy, a Democrat; insurers; academics; businesses; hospitals; and advocates for the poor, including religious leaders.
They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed by January, but state officials said they were confident that the federal government would approve of Tuesday's bill.
"Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.
Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed."
He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."
Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they would have to pay a penalty that could be as high as half of what an affordable health care premium would cost.
Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."
One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance.
For several months the bill seemed stalled because the House and Senate leaders could not agree on the issue of charging businesses. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that would go toward paying costs for the uninsured and would be reduced as more people became insured, Mr. Travaglini said.
Because the bill is part of a budget bill, Mr. Romney has line-item veto power. He said Tuesday that he would likely change the business fee provision in some way or veto it before signing the bill.
Still, he did not seem that worried about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it.
Bob Baker, president of the Smaller Business Association of New England, said his members seemed to accept the idea of the fee.
"The notion of the level playing field, I think from an element of fairness and equity, people are O.K. with it, unless it impinges on their ability to pay for it," Mr. Baker said. "There hasn't been a hue and cry among our members."
Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance."
James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed.
"I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said, but he added, "We would have liked more flexibility in the design of health plans to permit lower premiums that are affordable for all people."
The program, which was approved 154 to 2 in the House and 37 to 0 in the Senate, will cost $1.2 billion over three years, but only $125 million of that will be new state money. The rest will come from federal money and existing state money. After three years, lawmakers say, no new state money will be required. A new agency will administer the system.
Advocates for the uninsured held a victory rally at the Statehouse.
"We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization.
Joseph Landais, 64, could use insurance for himself, his wife and three children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's aide, makes too much for the family to be eligible for Medicaid but not enough to afford insurance. He had a hernia operation four months ago that he did not have to pay for under the free-care pool, but he had not been able to see a doctor since then, even though he is still not feeling well.
"After years that you've been working that hard," Mr. Landais said, "I think you deserve something back."
Katie Zezima contributed reporting for this article.

Statement by AFL-CIO President John Sweeney on Massachusetts Health Care
Reform
April 05, 2006

Who would have thought that Massachusetts - long considered a bastion of progressive thinking - would take a page out of the Newt Gingrich playbook for health care reform? Forcing uninsured workers to purchase health care coverage or face higher taxes and fines is the cornerstone of Mr. Gingrich's health care reform proposals. And it is unconscionable that Massachusetts has adopted this misguided individual mandate.

This legislation leaves middle-income families dangling without a safety net, jeopardizes families who currently have employer-sponsored health care, and gives employers a free ride.

The bill protects workers with the lowest incomes, but punishes middle-income families. A typical family in which the husband and wife each earn a little more than $30,000 and who have two children would be forced to purchase health care, but would not be qualified for any help even if their employer does not offer any coverage or they can't afford their share of the premium. With the average employer-sponsored insurance premium costing more than $4,000 a year for single workers and close to $11,000 a year for working families, Massachusetts' new requirement will bankrupt many middle-class families.

The state has promised to come up with an affordable health care plan but has been woefully short on details. While the state's promotional materials say, "everyone who can afford health insurance should be required to obtain it," it does not define affordable or provide any guarantees. Is it affordable for a single person making $30,000 a year to spend $3,000 (the amount currently being floated) on a stripped-down health care plan?

We believe that workers have to participate in the solution to the problem, but this plan puts the entire burden on workers while letting employers off the hook. Businesses that do not offer insurance will be assessed a paltry $295 per worker per year, an amount so meager that it actually creates an economic incentive for many businesses to pay the assessment rather than provide health care for their workers. In addition, the legislation is so vague that it is not clear whether employers actually have to provide coverage in order to avoid paying the assessment, or if simply offering coverage is enough.

The Massachusetts House of Representatives had it right when they passed the original House version that carried real penalties for employers who refuse to do the right thing. But the final version of this so-called health care reform plan will undermine employer-sponsored health insurance in Massachusetts and quite possibly -- if other state legislatures prove to be as shortsighted as the Massachusetts General Court -- in the country.

States are passing groundbreaking and precedent-setting laws. But we hope this is one precedent no other state will follow.

http://www.commondreams.org/news2006/0407-02.htm

FOR IMMEDIATE RELEASE
APRIL 7, 2006
6:00 AM

CONTACT: Mass-Care
Benjamin Day - Mass-Care
Phone: (617) 723-7001
Fax: (617) 723-7002
E-mail: info@masscare.org

 

Massachusetts Health Care Bill Will Disappoint, Hurt Low-Income Families, Say Advocates and Policy Experts

BOSTON - April 7 - Once again, health care advocates and experts are now saying, Massachusetts is attempting to extend health coverage to the uninsured without in any way addressing the spiraling costs of the state's health care system. "This week's proposals merely repeat one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill," say Steffie Woolhandler and David Himmelstein, Professors of Medicine at Harvard University. "That plan imploded within two years, and
Massachusetts' new health reform legislation looks set to repeat that disaster."

The Bill includes provisions requiring that uninsured families purchase at least stripped-down, poor quality health insurance through the
private market, or face stiff penalties on their tax forms. "This mandate throws financially-struggling individuals into battle with insurance agents, insurers, and caregivers," say Alan Sager and Deborah Socolar, Directors of the Health Reform Program at Boston University's School of Public Health. Even these poor, low-premium plans are likely to cost low-income families and individuals far more than they can afford, and the Bill does not raise enough funds to subsidize even a fraction of these new costs. The Bill
raises only $170 million per year to subsidize the new financial burdens now placed upon the uninsured, which is "a drop in the bucket of Massachusetts health care, where spending this year will be $59 billion," according to Sager.

Uninsured individuals who are at three times the poverty line, and to whom the Bill promises no financial assistance, will be forced to pay over 20 percent of their income to cover health care costs, according to the best estimates available. While real incomes for the poorest five percent of the population have been falling and may continue to fall, the health care costs they will now have to pay are likely to continue to rise, particularly since individual health plans are the costliest on the planet. "The Bill will worsen the complex and costly administrative system that wastes funds needed to pay for actual health services," says Alice Rothchild, MD, Board President of the Alliance to Defend Health Care. The Bill is also likely to encourage employers currently providing health care for their workforce to
push employees into the individual mandate, as the fees imposed by the new legislation on employers not covering their workers are far lower than the costs of the poorest-quality workforce health plans in the State.

"This Bill is going to exacerbate the crisis in Massachusetts health care," comments Sandy Eaton, RN, Chair of Mass-Care. "It will move more people into individual health plans, the costliest and most wasteful insurance plans on the planet, without taking any steps to contain the costs that neither the State, nor its employers or its residents can afford. Only a plan that consolidates health care finance and streamlines delivery, such as the single-payer model adopted successfully in much of the rest of the world, can provide quality, sustainable health care for all."

 

The Good and Bad for America in Massachusetts' New Universal Health Care Model
The Foundation for Taxpayer and Consumer Rights (FTCR) is a nonpartisan consumer advocacy organization. For more information, visit us on the web at: http://www.ConsumerWatchdog.org

Santa Monica, CA -- The Foundation for Taxpayer and Consumer Rights (FTCR) today warned that a Massachusetts universal care plan, which includes a requirement that individuals and families buy health insurance, not be considered a national model. Massachusetts's nonprofit health care market and existing laws are unlike most markets in the nation.
FTCR voiced concern about the affordability of the law, which requires families of three who make more than $48,000 per year to buy health insurance without any limits on what the insurer can charge. A true universal coverage model would use the bulk purchasing power of a public health program like Medicare that pays doctors and hospitals directly at the most efficient price with the lowest overhead and fewest middlemen.
The consumer group called for insurance premium regulation to guarantee affordability and warned against adoption of individual purchase mandates in states dominated by for-profit insurers.
FTCR pointed out what's good and bad in the new Massachusetts model:

GOOD:
  *       Massachusetts is dominated by not-for-profit insurance companies, so profiteering is limited, unlike in the national and California markets, where high-overhead for-profit companies dominate.
*       The state requires insurers to sell policies to every similarly situated individual at the same price regardless of health status, past medical conditions, age or gender -- unlike the underwriting that exists in most markets. In most states, including California, insurers may charge more, raise rates or simply refuse coverage to the sick.
    *       Massachusetts' new rules will pay doctors and hospitals more for better health outcomes and cost reductions.

BAD:
        *       Individuals have to pay for heath insurance or face tax liens that criminalize them, but there is no state limit on or regulation of how much insurers can charge. Massachusetts should require insurers to receive prior approval from the state for all rate increases.
       *       Patients with good health insurance through their employers may lose coverage because the bill allows employers to switch to "bare bones" high-deductible policies. Employers that don't pay for coverage under the new law pay only a $295 per year per employee fine -- a token provision.
    *       High-deductible plans encouraged by the new law will discourage preventive care and early diagnosis of disease -- which saves lives and money. Individuals will have to navigate a maze of policies that cannot be easily compared, as in the privately administered Medicare Part D drug benefit.

 

Massachusetts Health Plan a Poor Choice for New York: Just Follow the Money
Statement by Leonard Rodberg, PhD, NY Metro Chapter of Physicians for a National Health Program
This statement is based on the earlier statement prepared by David Himmelstein and Steffie Woolhandler, on materials from the Mass. Chapter of PNHP (available at www.pnhp.org), and on material prepared by Alan Sager and Debbie Socolar of Boston University's Health Reform Program (www.healthreformprogram.org).

The health insurance package passed by the Massachusetts legislature several days ago has been touted by its advocates as providing „universal health insurance coverage‰ for the citizens of that state. Some, including William Weld, the former governor of Massachusetts now seeking that position in this state, has proposed the Massachusetts plan as a model for New York. This would be a serious mistake. The Massachusetts plan gives new money to insurance companies and large medical centers, but it will do little for the nearly 750,000 citizens of that state who lack insurance today.

The Massachusetts plan is a cruel hoax. As long as the wasteful and unnecessary private insurance companies are kept in the system, costs will continue to rise and the numbers of uninsured will climb as well.

What‚s in the New Bill?
The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine to the state.
To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.
Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs.
What‚s Wrong With This Picture?
The linchpin of the plan is the assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that but few of the uninsured can.

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans, but it offers no specifics. The subsidies in the plan are completely inadequate: To cover the cost of health care for the uninsured, estimated at between $700 million and $4 billion each year, the plan provides a mere $125 million.
The only way to get cheaper plans in this situation will be to strip down the coverage, boost copayments and deductibles, remove services from coverage, etc. Governor Romney has suggested an insurance policy costing $2400 per year per person (or $9600 for a family of four) but has offered no details on this proposed policy. In neighboring New Hampshire a policy costing $2484 is available for a single 30-year-old non-smoking woman and offering the following coverage:

  ·       $1000  deductible before insurance pays anything
·       20% co-payment on covered services for the next $5000
·       Inpatient mental health capped at $2500 each year
·       Outpatient mental health 50% of charges (including drugs), maximum $40 per day
·       No coverage for routine preventive care, gynecologic exams, or maternity care
Such a plan would not protect people from huge bills if they were to become seriously ill. Hence, the requirement that the uninsured purchase coverage will either require them to pay money they don‚t have or buy nearly-worthless, stripped-down policies that represent coverage in name only.

Equally important, the legislation will do nothing to contain the skyrocketing costs of care. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, continually rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid and the subsidies promised in the reform legislation. This program is simply not sustainable over the long or even medium term.
What Are the Alternatives?
The legislation offers empty promises and ignores real and popular solutions.

A single payer universal coverage plan could cut costs dramatically by streamlining health care paperwork, making health care affordable. Study after study by the Congressional Budget Office, the General Accounting Office, and respected private consulting firms have confirmed that the savings in administrative costs from a single payer system will be more than sufficient to provide coverage for everyone, without any additional spending at all.

And single payer is popular. Surveys show that consumers, labor, seniors and even many business leaders support such a plan. National polls find that almost two-thirds of Americans favor a tax-funded plan like Medicare that would cover all Americans.

But single payer national health insurance threatens the multi-million dollar paychecks of insurance executives and the outrageous profits of drug companies and medical entrepreneurs.

It‚s time for politicians to stand up to the insurance and drug industries and pass health reform that can work.

 

SPECIAL INTERESTS DOOM
MASSACHUSETTES HEALTH CARE REFORM BILL

Merrick, New York, April 10, 2006 - „You have to wonder why the Commonwealth of Massachusetts‚s legislature and Governor Mitt Romney would pass a health care reform bill that:
1) requires its citizens to purchase private health insurance products sold for a profit and that treats patients the same way it does cars[1]
2) lacks specificity ˆ the State has yet to write language creating a sliding scale of affordability and relies on new products not yet released by insurance companies[2]
3) requires employers that don‚t pay for coverage to pay a fine of only $295 per year per employee ˆ a token provision [3] .  Currently, employers that do provide health insurance coverage spend at least ten times that amount for their employees in the state and
4) is not a solution for one of the most complex and perplexing socioˆeconomic problems facing the United States-- the outrageous rising cost of health care services.
 
The Bill does little to address the underlying causes of skyrocketing health care costs in Massachusetts ˆ billions of dollars spent on layers of wasteful administrative duplication and government bureaucracy, rather than patient care.‰ stated Tom Garvey, Chairman, Board of Directors, TheCenter for Health Care Policy Research and Analysis, an organization committed to resolving the uninsured problem and preventing the thousands of premature deaths of uninsured Americans that occur each year.

Mr. Garvey further stated, „The Massachusetts legislation appears to be an example of the executive and the legislative branches of state government cooperating with insurance and HMO lobbyists to prevent effective health care financing reform from developing.
The excessive influence of special interests, led by health insurance, hospital system, and employer-organization lobbyists, effectively halted passage of a funding mechanism that would have been more equitable and sustainable for the citizens of Massachusetts.

Furthermore, Mr. Garvey stated, "What will this legislation actually accomplish? It will:
1) neutralize and STOP meaningful health care reform initiatives in the state;
2) take the political pressure off the state politicians by stopping an intended ballot initiative on financing reform that calls for a 5-7% payroll tax and 60 cent cigarette tax increase and
3) provide a huge increase of taxpayer dollars funneled to the insurers and HMOs.

Unfortunately, this is not Universal Health Care or even Health Care Financing Reform, it is simply a diversion and subversion of vital public policy dollars that will eventually harm the 637,000[4] uninsured state of Massachusetts residents and 45 million uninsured Americans[5]

We must stop death by uninsurance and health industry profiteering.

For more information please contact: Tom Garvey at (516) 379-6812 or  (800) 442-6177, 2005 Merrick Road # 234, Merrick, NY 11566



[1] Mass Bill Requires Health Coverage, Washington Post Staff Writer, David A. Fahrenthold, April 5, 2006

[2] Massachusetts Sets Health Plan for Nearly All, NY Times, Pam Belluck, April 5, 2006

[3] The Good and Bad for America in Massachusetts‚ New Universal Health Care Model, The Foundation for Taxpayer and Consumer Rights (FTCR), April 5, 2006

[4]  Insuring America‚s Health: Principles and Recommendations, Institute of Medicine (IOM) of the National Academies, January 2004, Table A.3, Distribution of Uninsured Population, Under 65 and Probabilities of Going Without Coverage, By State of Residence, 2002, page 166.

[5] U.S. CENSUS BUREAU, Economics and Statistics Administration, Income, Poverty, and Health Insurance Coverage in the United States: 2003, Figure 6. Number Uninsured and Uninsured Rate:  1987 to 2003, Page 17, Issued August 200