Mass. appeal: A plan to cover the uninsured

The calendar has again turned to Cover the Uninsured Week -- this year May 1-7 -- spearheaded by the Robert Wood Johnson Foundation in partnership with 17 other major organizations and foundations, including the AMA. Since 2003, this event has put a much-needed spotlight on the biggest public health crisis in America today: the rising ranks of the uninsured.

The AMA has been a supporter of Cover the Uninsured Week from the beginning, a fitting partnership given that event's goal is also a key element of the Association's health care advocacy agenda. This year, as in the past, there will be numerous events around the country -- including many sponsored by the AMA's Medical Student Section -- designed to raise awareness of the problem of 46 million Americans without health insurance. An important focus will be on those programs that already exist, such as state-funded child health insurance, that the uninsured can turn to in seeking care.

A major milestone in that regard occurred just about a month before Cover the Uninsured Week. The Massachusetts Legislature passed a bill with a goal of enabling every resident in the state to have health insurance. And it does so in a way that takes into account much of what the AMA has proposed for solving the uninsured problem -- a bottom-up, consumer-driven system, rather than a top-down, government-imposed solution.

AMA policy supports the use of tax incentives and other non-compulsory measures to encourage individuals to purchase health insurance coverage. The Massachusetts bill, signed by Gov. Mitt Romney, does just that. It sets up a system that uses the private sector and public incentives to achieve universal coverage for all residents.

The plan does not require Massachusetts residents to buy health insurance, but it contains strong incentives -- and in some cases, strong assistance -- to make sure they do.

By July 2007, state residents who do not get insurance through their jobs must buy insurance if they make more than 300% above the federal poverty level -- $60,000 per year for a family of four -- or else forfeit a $150 state tax exemption they would normally subtract on their state income tax forms. Then, in future years, an additional tax equal to no more than half of the cost of the cheapest health policy would be assessed. Residents whose incomes range from the poverty line to 300% above, and who do not have insurance through their employer, also must purchase a health policy, though the state would subsidize their purchase on a basis inversely related to income. Uninsured residents below the poverty line would be able to get subsidized plans that have no premiums and would carry small co-pays for emergency department visits and other services.

Meanwhile, businesses with 11 or more employees that do not offer health insurance would pay a fee of $295 per employee per year. Romney rejected this provision with a line-item veto, though the Democratic-controlled Legislature is expected to override it.

It's encouraging to witness the overwhelming bipartisan support that the Massachusetts bill received. The Massachusetts House passed the bill 154-2, and the Senate passed it 37-0. Romney, a Republican, got help from his former U.S. Senate race opponent, Sen. Edward Kennedy (D., Mass.) to get the Medicaid waivers necessary to put this plan in place.

Also worth noting is that the measure passed with the support of the Massachusetts Medical Society. The AMA has encouraged other state medical societies to work with their legislatures to get such a system passed.

While Massachusetts points the way for other states, access for all Americans can be achieved soonest at the federal level. The AMA wants the topic of covering the uninsured to be high on the agenda in the 2006 congressional campaigns and a top priority in the 2008 presidential election.

For now, as Cover the Uninsured Week puts a spotlight on just how big a problem the nation faces, Massachusetts provides hope that it may someday be solved.