In Massachusetts, test for a pioneering health plan
Its new insurance mandate kicks in July 1. Some see a model for the rest of the US.
One of the most ambitious healthcare initiatives by a US state is entering a make-or-break implementation phase – just in time to become a model of success or failure for presidential candidates.Skip to next paragraph
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Starting next week, on July 1, most residents of Massachusetts will be required to carry health insurance, even if their employer doesn't provide it and even if they aren't eligible for a government-subsidized plan.
Already the Massachusetts experiment offers at least two lessons: First, a major healthcare overhaul is possible, despite all the competing interest groups. Second, a big change doesn't mean a quick fix. The state has already scaled back its early hopes that all residents would be covered.
The implementation here comes as pressure mounts on politicians nationwide to restrain rising medical bills and extend health insurance to the roughly 15 percent of Americans who lack it. Polls suggest that most Americans view the current healthcare system as broken. Federal and state budgets are strained by medical inflation. Increasingly, businesses also see a crisis – one that affects their ability to compete in world markets.
For the nation, the tough choice ahead is to define the solution. Does it involve putting more responsibility with government, with individuals, with employers, or some blend of these? What's being tested in Massachusetts is a hybrid approach, but one that puts substantial obligations and choices with individuals.
The Bay State plan has skeptics and detractors on both left and right. Supporters say that fact hints at the plan's balance – and at why it might succeed.
The plan represents a compromise of ideas proposed by Republican Gov. Mitt Romney, now out of office and running for president, and Democratic lawmakers.
"It's coming right down the middle," says Jonathan Gruber, a professor at the Massachusetts Institute of Technology who helped shape the Massachusetts plan. "It's sort of an American approach to universal coverage."
Canada and many European nations cover all their citizens through systems in which the government alone pays for healthcare. Whatever path America takes, a central challenge is how to balance the goals of coverage and cost control. Americans can only be covered if they can pay for it, whether that payment is individual or collective.
The Massachusetts plan outlines a base level of required coverage and encourages competition among insurance providers. A new state-created marketplace, called the Commonwealth Connector, provides the forum for individuals and families to compare health plans online just as they would airline tickets. Gold, silver, and bronze labels give clues about the scope of coverage. The prices also vary by age and occupation. One "bronze" plan, for example, would cost $370 a month for a 50-year-old Bostonian who works in retailing.
"This plan will insure the uninsured. That's very laudable," says Regina Herzlinger of Harvard University in Cambridge, Mass. But she'd like to see consumers empowered with more insurance products in the "supermarket," and more information about their effectiveness.