Universal Health Care Gets A Chance

washingtonpost.com: By Christopher Lee

BOSTON -- There is a lot of talk about overhauling health care in the United States, but Massachusetts is actually trying to do it -- again.

Today, the home of some of the nation's most prestigious hospitals and medical schools becomes the first state in the nation to require its 6.5 million residents to have health insurance or face financial penalties. Making insurance mandatory -- and more affordable -- is the centerpiece of a law approved by the legislature last year that civic and business leaders hope will dramatically reduce the ranks of the state's 400,000 uninsured and the number of people who seek costly 'uncompensated' care in hospital emergency rooms. ...

The government, for its part, is defining basic coverage and trying to make insurance more affordable. Under its new Commonwealth Care program, it is subsidizing coverage with no annual deductible on a sliding scale for people with incomes of up to 300 percent of the federal poverty level, or $61,950 for a family of four. About 130,000 low-income people are already enrolled either in Commonwealth Care or MassHealth, the state's Medicaid program, state figures show. The poorest pay no premiums.

Those who do not qualify for subsidies and cannot get coverage through their jobs can buy low-cost but unsubsidized health plans offered by private insurers through the Connector under the Commonwealth Choice program. Premiums go up with age, but people cannot be charged more if they are sick or are denied coverage because of a preexisting condition.

Costs are still too high for some. Already, state officials expect to exempt 60,000 residents from the new mandate because they cannot afford the insurance at the going rates, even though they earn too much to qualify for subsidies. That is a big reason that Massachusetts is destined to fall short of universal coverage under the new law...

"Affordability is the big question here," said Kathy Swartz, a professor at the Harvard School of Public Health, who noted that even those with a basic plan still could face high deductibles. "It's certainly what a lot of other states are wrestling with -- how do you bring the costs down?"