National Nurses United

NewsBriefs_MArch 2011 3/17/11 9:26 PM Page 6 NEWS BRIEFS Massachusetts' Failed Experiment with the Individual Mandate MASSACHUSETTS P robably the most controversial feature of both the Massachusetts health reform of 2006 and the federal health insurance reform of 2010 is the individual mandate, the legal requirement that every resident have health insurance coverage or suffer penalties at tax-filing time that escalate each year. In Massachusetts, we've now had considerable experience with this, and the results have been a disaster. The Massachusetts Plan, with the individual mandate, is not universal, not sustainable, and not fair. For the people of Massachusetts, the mandate has proved to be a tremendous personal and financial burden for little benefit. Some citizens have gone to great lengths and suffered severe personal costs to comply, even keeping their income down to avoid entering a less-subsidized bracket. Others have resisted being forced into the managed care plan provided for them, preferring to suffer the penalty than be denied access to their own out-of-network providers. The state only considers the cost of the premium in determining what is affordable, not the costs of deductibles and copays. As we all know well, the lower the premium, usually, the higher the deductible and other out-ofpocket costs. Individuals and families are buying essentially worthless policies that they can't afford to use. Many families with insurance have had to choose between food, heat, and rent or accessing needed medical care. For those who successfully argue that they cannot afford available coverage and are granted an exemption to avoid being penalized, the fundamental problem remains: They still lack access to healthcare due to high costs. The number of exemptions is also rapidly growing. And Chapter 58 has required an incredibly complex bureaucracy, which makes individuals extremely vulnerable to falling through the cracks. For the state of Massachusetts, the individual mandate has failed to prevent skyrocketing healthcare costs that threaten to 6 N AT I O N A L N U R S E patient protection legislation before Question 5's narrow defeat at the polls that November. In addition, the Massachusetts Labor Party had placed non-binding single-payer questions on a number of local ballots from 1998 on. In response, Blue Cross Blue Shield of Massachusetts in 2001 created a foundation to promote a different agenda. The Blue Cross Blue Shield of Massachusetts Foundation, over the course of several years, succeeded in narrowing the range of acceptable public discourse to insurance access through its Roadmap to Coverage initiaundermine the whole program. Sandy Eaton, RN tive, projected through a series With no restrictions or regulaexplains the individual of annual "stakeholders" confertions on how much insurance mandate to a group ences, and through generous companies can charge, the govof single-payer grants to groups that endorsed ernment can't afford to keep supporters its approach. Access to health paying the subsidies at the heart insurance, rather than access to healthcare, of the individual mandate component. In became the goal of public policy. summer 2009, Massachusetts already Another source of pressure for action dropped coverage for 30,000 legal immicame from the impending expiration of the grants to cut costs and Gov. Deval Patrick 10-year-old Medicaid waiver worth $384 recently proposed as part of next year's million a year. The Bush administration budget slashing payments to providers as needed to see a plan in place before July 1, well as making Medicaid recipients pay 2006 that would control costs by pushing higher copays. more Medicaid recipients into managed Massachusetts' experience with the indicare plans and elimination of the Uncomvidual mandate bodes poorly for President pensated Care Pool, sometimes called the Obama's national healthcare reform. "free care pool," a product of reform in the It's important for us to understand what 1980s that spared hospitals from bad debt led up to this onerous mandate. Back in and saved many working families from 2000, real pressure for changes to our bankruptcy. healthcare system was mounting. As pressure from various sources mountThe Massachusetts Nurses Association ed in 2005 for serious reform in Massachuhad provided valuable resources to the setts, Republican Governor Mitt Romney, movement to pass Question 5 on the state ideologically and financially tied to the conballot in 2000 to enact a managed care bill servative Heritage Foundation, floated a of rights for patients and clinicians, a universal healthcare system by July 2002, and a trial balloon for the individual mandate that was widely lampooned. moratorium on conversion of healthcare But on Oct. 8, 2005, at a vast assembly of facilities and services to for-profit status "stakeholders" convened by the Blue Cross until such a universal system was in place. Blue Shield of Massachusetts Foundation, That movement forced the enactment of W W W. N A T I O N A L N U R S E S U N I T E D . O R G MARCH 2011

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