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Insurance Mandate Is a Mass. Original But Other States Should Take Note, Official Says

MAY 8, 2006 -- A Massachusetts state official reiterated Monday that his state's new health care coverage mandate could be duplicated but the state had a unique advantage to model the system.

Speaking before a forum hosted by the nonpartisan Alliance for Health Reform, Timothy Murphy, Massachusetts secretary of Health and Human Services, explained the state's new plan and the lessons other states and the federal government could learn from the process.

The law, which was signed on April 12, will require the state's 6.4 million residents—550,000 of whom are uninsured—to obtain health care coverage by July 1, 2007. The law also will subsidize premiums on a sliding scale for people earning below 300 percent of the federal poverty level.

Nationally, nearly 46 million people are uninsured.

Massachusetts started from a better place than most states for near-universal health care, said James Mongan, president and CEO of Partners HealthCare. The state already mandated hospitals to provide emergency care for the uninsured. Also, only 10 percent of Massachusetts residents are uninsured compared with the national average of 15 percent.

"Being a blue state made the legislation possible in Massachusetts," Mongan said.

Edmund Haislemaier, a research fellow at the Heritage Foundation, disagreed, saying the plan was repeatable in other states, regardless of politics. The conservative Heritage Foundation assisted in the development of the plan.

"What the state did was get to the facts and check ideologies at the door," Murphy said.

To gain Republican support, Massachusetts GOP Gov. Mitt Romney cast the idea as based on personal responsibility.

Murphy attributed the state's success in how it changed the framing of the health care debate to focus on the patients or consumers rather than the providers.

"It promotes a culture of insurance and personal responsibility with a keen focus on cost-containment and efficiency strategies," Murphy said.

Universal health care attempts in other states and federally have failed for focusing on products, such as health savings accounts, rather than focusing on a broad overhaul, Haislemaier said. States also should focus first on getting more and better use out of current funding levels before assuming new money is needed. However, Massachusetts again had an advantage by having a larger pool of money for the uninsured before the law.

The law has faced some resistance from Romney, who struck down from the measure key provisions, including one that would implement a fee of $295 per employee for employers with 11 or more full-time workers who do not offer or contribute to workers' health coverage.

The Massachusetts House overturned the vetoes on April 25. The Democratic-controlled Senate followed on May 4 by restoring six of eight sections of the new law that Romney had vetoed, including the business penalty.

Murphy defended the penalty, saying it was a modest penalty and a compromise between Democrats and Republicans.

He acknowledged "heavy lifting" would be required to replicate the system in other states but said the plan could at least change the way people think about the health care problem.

Murphy acknowledged that aspects of a current federal bill (S 1955) could cause Massachusetts to reassess its new health care plan. The legislation by Sen. Michael B. Enzi, R-Wyo., would make it easier for small businesses to band together to offer health insurance, primarily by allowing insurers to sidestep state coverage mandates.

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