Editorials

Providing Americans "universal" health coverage is something some politicians have talked about for years and it could be a topic of increasing debate in the presidential campaign.

Nobody really has a clue how it could be done successfully. So, a lot of eyes have been on Massachusetts where a health reform initiative is seen by many as a model for the nation.

Massachusetts Democrat Gov. Deval Patrick has been talking about how the initiative has reduced uninsured in the state by half, with nearly 300,000 more people added to the health insurance rolls.

He doesn't talk much about "the rest of the story."

Out of the new enrollees, four out of five are relying heavily on taxpayer subsidies for their coverage, said Grace-Marie Turner, president of Galean Institute, in an article published in Health Care News.

Of the 293,000 people newly insured in Massachusetts 160,000 earn less than $63,600 (for a family of four) and are enrolled in taxpayer-subsidized plans. More than half of them pay no premiums and most others pay only a modest amount. Also, 70,000 were added to the rolls through expansion of the state's Medicaid program with only 63,000, about one in five, having purchased private insurance.

In addition, about 60,000 are being declared exempt from the mandate all citizens must buy coverage, Patrick said, showing how elusive the goal of universal coverage will be, even for a state that had a relatively low uninsured population to start.

Costs still are a problem for the Massachusetts plan. The state government estimates its annual spending on the new program for the uninsured may exceed its budget by nearly $150 million.

Individuals who fail to comply face a steep penalty - a fine of $912 for those who don't get insurance or an exemption this year. That is four times the penalty last year and it is scheduled to increase each year.

State negotiations with participating insurers to keep premium increases to about 5 percent this year were met with claims that in order to keep prices down, co-payments and/or deductibles will have to increase or benefits reduced.

Another problem cited by the newly insured is a difficulty finding primary care physicians who will see them.

To show how hard it will be to get to a point everyone will be able to get "coverage as good as members of Congress have" in Massachusetts, Turner said, a gold-plated BlueCross Blue-Shield plan in the program would cost a family of four about $23,000 a year.

Then there is the issue of what to do with businesses already offering coverage but whose policies don't comply with the higher government standards. The options appear to be exemption, mandated more expensive coverage or fines.

A new poll on health care from National Public Radio, the Kaiser Family Foundation and the Harvard School of Public Health found "a majority of Americans are backing key elements n health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama."

Turner pointed out, however, that when asked whether they would support an individual mandate for health insurance, 59 percent said yes, as long as employers were required to provide coverage or pay a fee, and as long as there were subsidies for those with low incomes and insurance companies were required to take anyone who applies.

"But when the question was asked a different way - without emphasizing government subsidies, employer mandates and requirements on insurance companies - support dropped to 47 percent in favor and 44 percent against," said the release issued by the poll's sponsors. "That's an even split, given the poll's margin of error of plus or minus 3 percentage points."

That led to a final conclusion that, "support for requiring everyone to buy insurance may be iffy."

The Massachusetts "universal health" plan is not proving to be a miracle example for the nation to follow.

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