Senators Offer Plan to Deliver Health Coverage to Half of State's Unisured
By Amy Lambiaso and Michael P. Norton for State House News Service
       Taking aim at a big problem, state senators Thursday outlined a pair of bills designed to promote to development of more affordable health insurance products, boost employer and employee insurance subsidies, and invest in programs aimed at preventing the onset of health problems.
       Senators said their plan, if enacted, would lead 140,000 presently
uninsured residents to sign up for new private market plans, add 70,000
people to the state's Medicaid program, and insure 30,000 individuals by
expanding subsidies to small businesses. Senators estimated 532,000
individual in Massachusetts do not have health insurance and said their
plan would lead to coverage for half of that population within two years of
the plan’s enactment.
       The plan outlined by a handful of Senate Democrats does not call for new taxes or require businesses to offer insurance to their workers, but it
would assess a new "free rider" charge on large employers who don't offer health insurance employee health care costs picked up by the
state-administered uncompensated care pool.  Similarly, the plan calls for
charges on employees who decline coverage and then turn to the pool to pay their health bills.
       The plan's authors say the state can spend its health care dollars more wisely, noting that $1.1 billion is already spent each year - funded by hospitals, insurers and taxpayers - to reimburse providers of
"uncompensated care" through the pool. It would increase such
reimbursements by $90 million a year for four years - $45 million of which
is state money matched by the federal government.
       Ronald Hollander, president of the Massachusetts Hospital Association, said hospitals and other providers are currently reimbursed roughly 70 percent of their costs for treating the uninsured, a cost which is unsustainable.
       “This would be a giant step,” he said.
       Led by Senate President Robert Travaglini, the plan’s authors propose spending $168 million, with all of the money drawn from the state’s rainy day fund, to boost Medicaid reimbursement rates and expand Medicaid enrollment as well as a partnership that helps small businesses and their employees to afford insurance costs. The federal government would cover $60 million of the proposed spending, the bill’s proponents said.
       “We will have to put the money upfront,” said Sen. Therese Murray
(D-Plymouth), chairwoman of the Senate Ways and Means Committee. “But eventually we’ll get the savings.”
       Gov. Romney filed his health care access expansion bills Wednesday, saying his proposals would result in all Massachusetts residents having health insurance by 2009. There are many differences between the governor’s plan and the Senate plan, as well as some major similarities. For instance, both plans aim to make private health insurance products more affordable and enroll many more people in Medicaid.
      The Senate bill would require health plans to offer coverage to adults up to age 25, offer individuals a tax deduction to promote health savings
accounts, and require a $100,000 study of whether all people should be
required to buy health insurance. The legislation also puts a moratorium
on new mandated benefits, while a study is conducted.
       The major difference between the two proposals, Travaglini said, is the Senate’s focus on increasing the state’s investment into prevention
programs, such as teen pregnancy and suicide prevention, cancer screening, and tobacco cessation programs. The $25 million annual investment would bring the state closer to its spending before the fiscal crisis hit three years ago, Murray said.
       Geoff Wilkinson, executive director of the Massachusetts Public Health
Association, said the state’s public health programs have been cut by more than $100 million during the last four years, and called the Senate’s
commitment to restoring some of that money a “major shift in the discussion.”
       In addition, the Senate’s plan – which is co-sponsored by Murray, Health Care Financing Committee Chairman Sen. Richard Moore (D-Uxbridge), and Community Development and Small Business Committee Chairwoman Sen. Harriette Chandler (D-Worcester) – would offer voluntary safe-staffing plans for hospital interns, residents and fellows to reduce long shifts, and increase flexibility for local cities and towns to choose health care plans.
       To improve accountability and foster market competition, the Senate plan establishes a state board to evaluate and monitor health care providers, and a web site to post the information for consumers.
       In developing the Senate plan, Travaglini said he was mindful to avoid
mandates that require employers to “pay or play.” And while this plan would assess a surcharge to employers and employees for misusing the free care pool, Travaglini said he does not consider that a mandate.
       “I don’t interpret it as a mandate, and none of the people standing behind me interpret it as a mandate,” he said during a press conference in the Senate Reading Room. “This is triggered by something else.”
       Senators two legislative proposals today, joining several other proposals to expand health care access and insurance coverage for this session. Romney filed his Commonwealth Care plan as a pair of bills on Wednesday, while Moore is sponsoring a bill to increase the cigarette tax to pay for expanding health care coverage, and the advocacy group Health Care For All is pushing for a plan that includes an employer mandate.
       Lawmakers last year advanced a constitutional amendment to require the Legislature to draft a plan to deliver health care coverage to all state
residents and present that plan to the voters for their approval. Barbara
Roop, who is leading the effort for the amendment, said she was “very
impressed” with the Senate plan, but said the constitutional amendment is the glue needed to keep expanded health insurance access efforts in place.
       “The constitutional amendment ensures that we will get it done and it will stay done,” Roop said. “In the past, legislation alone doesn’t get it done.”