Covering everybody
For all the complaints about auto insurance, a state mandate guarantees that most Massachusetts motorists buy this essential coverage. It's about time to consider doing the same for health insurance, and Governor Romney offered an intriguing proposal yesterday to do just that.
The governor's plan, which he outlined at a forum organized by the Blue Cross Blue Shield of Massachusetts Foundation, fills out ideas he has sketched over the last few months to cover the 500,000 or so uninsured in the state. He would enroll in Medicaid the 100,000 people who qualify but have not signed up. The remainder could go into two new plans -- Safety Net Care, for those just above the Medicaid limit, and Commonwealth Care, for the more affluent.
As originally presented, Romney's plan failed to mandate that anyone get insurance. He addressed this yesterday by proposing that, unless they have work-based coverage or can prove they are wealthy enough to pay for care, everyone would have to enroll or face income-tax penalties. Now, sick people who lack insurance routinely seek treatment, defrayed by the uncompensated care pool. An individual mandate would be better than this creaky mechanism.
The Urban Institute, a respected Washington think tank, came to much the same conclusion in a report commissioned by the foundation. The institute found that the mandate, perhaps in conjunction with some sanctions on employers, offered the most comprehensive approach to coverage.
Unlike Romney, who did not foresee the need for new revenue, the institute figured that it would cost an extra $1.2 billion for a comprehensive approach. Romney is right that money now expended on the uninsured could be used to pay for the new plans, but given the high cost of health care the Urban Institute estimate may be more on target.
Romney, in a telephone interview, said a bill to implement his plan should be ready by mid-July. It will join an initiative from Senate President Robert E. Travaglini to make employers of 50 or more liable for workers' uncompensated-care costs if they do not provide coverage. Legislation from the advocacy group Health Care for All would increase the cigarette tax by 50 cents to pay for insurance. House Speaker Salvatore F. DiMasi needs to put forward his own ideas on the issue.
The Massachusetts auto insurance system is far from perfect, but it did cover 93 percent of motorists in 1995-97-- among the highest rates in the nation -- according to the latest available figures. Romney and the Legislature should devise a financially sound health insurance system that provides this necessity of modern life to an even higher percentage of Massachusetts citizens.
