The price of healthcare access

COMMONWEALTH CARE, the new state-subsidized insurance program, is enjoying too much success, which poses a challenge to the state's political leadership. Governor Patrick, House Speaker Salvatore DiMasi, and Senate President Therese Murray need to be willing to find new sources of revenue to keep people insured if the program comes in over budget next year.

Commonwealth Care is available to adults earning less than 300 percent of the federal poverty limit, or $51,510 for a family of three. The authority that administers the program had estimated that it would take until next June 30 to reach its goal of signing up 136,000 people. But already 133,000 have enrolled, fueling speculation that many more people will join by next summer. To avoid a state tax penalty, eligible people need to begin the enrollment process by today.

DiMasi has a special responsibility to keep Commonwealth Care viable. He was one of the triumvirate, along with then-Governor Mitt Romney and Senate President Robert Travaglini, that guided the health reform legislation into law last year. Unless Commonwealth Care is adequately funded, the state will be breaking its promise to help defray the cost of health insurance for people who are above the poverty line but cannot afford coverage on their own.

The state will get a better handle on Commonwealth Care finances by February or March, about the time that the four insurance carriers participating in the program propose rates for the next fiscal year. The state will also be in the middle of negotiations with the federal government to renew the special Medicaid support that is sending $236 million to Commonwealth Care this fiscal year.

No other state has ever tried to cover the uninsured in this way. Early cost estimates were bound to be imprecise. Perhaps the guesses about the number of uninsured were too low. But a short-term funding gap because too many people enroll in the program actually is good news.

Earlier this year Speaker DiMasi balked at the governor's proposal to close business tax loopholes, and he's skeptical of Patrick's plans to enhance revenues by legalizing casino gambling. DiMasi needs to show greater openness to new revenues if they became necessary to sustain Commonwealth Care. The federal government needs to continue its support as well.

No one ever said the rollout of this unprecedented program would be easy, but 133,000 people are now covered by affordable health insurance who without it would probably rely on catch-as-catch-can medical care subsidized by the state free-care pool.

Congratulations are due the state workers, hospitals, health centers, and healthcare advocates who signed up so many people. Let's hope that everyone who is eligible enrolls in Commonwealth Care. Massachusetts, with federal help, can afford to pay for it.