Healthcare heroes

APPROVAL OF a bill to provide just about everyone in Massachusetts with health insurance has attracted national attention, and justifiably so. The Legislature devised an innovative, comprehensive approach to a hitherto intractable problem. The plan ventures into uncharted policy territory and will require adjustments and probably more money, but it is a proud statement that government can improve the lives of its people.

Governor Romney deserves a good bit of credit as well. He decided to address the problem of the uninsured soon after he took office, but he rejected the first draft, which would have quickly covered the 500,000 or so uninsured at an additional cost of $800 million. He wanted nothing to do with new taxes, but he did want to make better use of money now in the uncompensated care pool, which pays the hospital bills of those who do not have coverage. He also kept pushing the idea that new kinds of policies could draw in people unwilling or unable to buy insurance.

The Blue Cross Blue Shield of Massachusetts Foundation has made expanded coverage a priority. It commissioned a study by the authoritative Urban Institute, which in late 2004 recommended that the state impose a mandate on everyone to get insurance. The Urban Institute argued that by shifting money from the uncompensated care pool, subsidizing coverage for people at lower income levels, and adding new revenues, the state could finally achieve the goal of universal coverage.

And starting last year, MassACT, a coalition of labor and religious groups, has been circulating petitions calling for a ballot question that would expand coverage by levying a hefty assessment on employers that do not provide insurance.

Salvatore DiMasi, the House speaker, came out with his own plan last October, which combined the Urban Institute's individual mandate, Romney's push for new insurance products, and the employer assessment. Senate President Robert Travaglini wanted to make sure that the Cambridge Health Alliance and Boston Medical Center, the two hospitals most dependent on the uncompensated care pool, would not be hurt in the transition to a new system.

There's a little bit of every one of these persons or groups in the bill passed last week, but no one got exactly what he wanted, with the possible exception of Travaglini, who protected the two hospitals.

Insurance companies will be encouraged to offer new kinds of policies, but thankfully they won't be the barebones variety favored by Romney. There will be an individual mandate, as the Urban Institute suggested, but it won't be buffered by subsidies expanded as far up the economic ladder as 400 percent of the federal poverty line ($66,400 for a family of three). To save money, the Legislature limited this to 300 percent. And at $295 a head on companies with 11 or more employees, the employer assessment is a fraction of what DiMasi and MassACT wanted.

But the plan has the advantage of an early deadline to force the pace of state policy makers and private insurers. By July 1, 2007, everyone in the state is to have health insurance. And the bill establishes a public agency, the Commonwealth Health Insurance Connector, to set the subsidies and approve the policies that insurance companies are expected to offer to their new customers.

The Romney administration is supposed to have the Connector in place within weeks and to begin paying out subsidies by Oct. 1. This is a tight deadline but, as the governor ventures out of state on his presidential explorations, the administration needs to keep to the timetable to show it is committed to the new healthcare program.

One big question is whether the new insurance policies will be affordable to people who don't qualify for the subsidies. The Legislature needs to be prepared to adjust the assistance levels to something like the Urban Institute's 400 percent of poverty, or otherwise act to make the policies less costly. Adjustments like these are inevitable, but in an age of straitened expectations and stingy government, Massachusetts should be proud that it is about to embark on an initiative to extend the benefits of healthcare to the vast majority of its population.