MA: Deal on Health Care -- But Is It Enough?

On Friday, legislative leaders in Massachusetts appear to have agreed to a compromise bill that would assess a modest fee on any business with ten employees or more which does not provide health care to their employees -- a key element of a broader plan to move towards universal health care coverage.

Business largely supports the compromise because the assessment is relatively small -- only $295 per employee not covered by health care insurance -- an amount far less than a proposed state House bill. Which explains why health care advocates are only cautiously celebrating.

John McDonough, executive director of Mass. Health Care for All, assesses the deal on the organization's blog here, here, and here. As McDonough writes, while the $295 assessment per business is woefully inadequate -- and allows companies to provide pretty nominal health care coverage and avoid any tax at all -- the deal involves a fundamental victory for advocates, namely establishing the principle that businesses have a legal obligation to provide for health coverage of their employees, either directly or through taxes paid to the state government.

"This is not the end, it's the beginning," writes McDonough, and with the principle of employer responsibility established, raising the assessment on businesses in the future will be far easier than establishing it in the first place. Massachusetts figures show the state already spends $212 million to provide health care to employees at larger firms -- and the number is no doubt far larger when smaller firms are included -- so the adequacy of the health care assessment will immediately become a key policy debate if enacted, so the debate will still be on advocates' terrain.

The deal in Massachusetts is an incremental victory, but by applying to most businesses in the state, it pushes the debate far beyond the law recently enacted in Maryland that applies only to large businesses like Wal-Mart. "If you don't go beyond Walmart," McDonough points out, "you're not accomplishing much of anything at the end of the day." Starting with Wal-Mart was always an incremental first step for the Maryland advocates, so starting with a more modest assessment on a larger base of businesses in Massachusetts is an alternative first step towards more comprehensive results.

And advocates are not sitting back-- they are ready to go to a ballot initiative if the final bill's details do not extend health coverage comprehensively to the uninsured in the state.

So health care advocates can be proud of a campaign in Massachusetts that is pushing the goal of universal coverage forward.

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