Massachusetts is to provide health care for 99% of populationBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.869 (Published 13 April 2006) Cite this as: BMJ 2006;332:869
Massachusetts is to provide health care for 99% of populationFlorida
After months of wrangling between the governor and law makers, both houses of the Massachusetts state legislature overwhelmingly passed a bill last week requiring all state residents to get healthcare coverage by 1 July 2007.
The plan was worked out with input from Democratic law makers, the governor (the Republican Mitt Romney), the Democratic senator Edward Kennedy, insurance companies, academics, businesses, hospitals, and advocates for poor people, including religious leaders.
The plan is projected to cover 515 000 uninsured people within three years, or 95% of the state’s uninsured people, leaving less than 1% of the total population unprotected. Officials put the cost at $316m (£180m; €260m) in the first year and more than $1bn by the third year, with much of that money coming from federal reimbursements and existing state spending.
People earning less than $16 000—the federal poverty threshold—would be able to get free or subsidised policies carrying no premiums. They would make small payments for emergency department visits and other services.
People earning between the poverty threshold and three times that amount would be able to buy subsidised policies whose premiums would be based on their ability to pay. People who can afford private insurance but refuse to buy it will face increasing tax penalties until they obtain coverage. People who are already insured will see a modest drop in their premiums.
The measure does not require new taxes but does require businesses that do not offer health insurance to their employees to pay a $295 fee per employee to the programme.
A new state agency will be created to administer the programme, once the law is enacted.
Governor Romney, who is a candidate for the 2008 presidency, said he would sign the bill. It would address an issue that polls show is a growing concern for US citizens, about 46 million of whom lack any healthcare insurance. The governor said, "I actually ran with healthcare reform as something I wanted to do. If there were national implications and applicability, that would be wonderful."
"To come up with a bipartisan plan in this polarised environment is commendable," said Hillary Clinton, a New York senator and leader of President Clinton’s failed healthcare campaign.
"It is not a typical Massachusetts-Taxachusetts oh-just-crazy-liberal plan," said Stuart Altman, a professor of health policy at Brandeis University, Massachusetts. "It isn’t that at all. It is a pretty moderate approach, and that’s what is impressive about it. It tried to borrow and blend a lot of different pieces."
Advocates for uninsured people held a victory rally at the Massachusetts State House, Boston. "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.
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