THE FIRST STEP TOWARDS HEALTH CARE FOR ALL

April 13, 2006

This week, Massachusetts became the first state to provide nearly universal health care coverage for its citizens. The bill does what a lot of health care experts and political observers thought was impossible - provide access to affordable health insurance for all of its citizens - and did it in a way that nearly everyone thought was impossible in this era of intense partisanship - through compromise.

I won't go into all the details of the plan here, but it does incorporate a lot of innovative methods and ideas from across the political spectrum and it spreads the cost of the program among businesses, individuals and the state of Massachusetts. It pushes the idea of personal responsibility by making health insurance a requirement for all citizens - much like automobile coverage - yet it also provides subsidies to make the coverage affordable for all.

The Massachusetts bill creates a sliding scale that matches the cost of the coverage with income, with subsidies for private plans available for people with incomes at or below 300 percent of the poverty level (just under $30,000 for individuals and $60,000 for a family of four). Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system.

There are also tax incentives to help small business and individuals. Massachusetts officials estimate that about 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Basic plans will be available to people ages 19 to 26 at bare bones costs.

The way it's funded is that individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government will also work with private insurers to provide lower cost plans to more low-income working families. In addition, businesses with more than 10 workers that do not provide insurance will be charged up to $295 per employee per year. As a result, state officials expect that most Massachusetts residents will still get health care through their employers.

As you can imagine, there are going to be a lot of eyes on Massachusetts over the next few years to see how this all works out. State officials in Minnesota will be watching, as well.

There was a time, however, when Minnesota was the state being watched when it came to health care. We were on the verge of near-universal coverage back in the early 1990s when we were putting together the MinnesotaCare program. Unfortunately, universal access to the program was pulled out of the bill in order to ensure that it would pass. Despite the success of the program, access continues to be limited.

Massachusetts was finally able to make this leap because of leadership and a willingness to work across party lines. Governor Mitt Romney, a Republican, Senator Edward Kennedy, a Democrat, Democratic leaders in the House and Senate, insurers, health care experts, businesses, religious leaders and advocates for the poor all got together and agreed on a goal - near universal coverage - and then hammered out a compromise plan that got them there.

It was refreshing to see. I only wish we were having this discussion in Minnesota. I've long maintained that the states that get a handle on our current health care crisis first are going to have a leg up on the rest of the country when it comes to attracting businesses and creating jobs and economic opportunity. Massachusetts looks like a leader right now in that regard. We can't afford to fall too far behind.