04/06/2006 The Massachusetts Health Care Model

Thursday, April 6, 2006

Valuing Families

The Massachusetts Health Care Model: Expanded Coverage with a Heavy Burden on Working Families

Every Massachusetts resident will be required to have health insurance by July 2007 -- with a combination of governments subsidies, employer assessments and individual fines used to achieve that result under legislation which was approved by the Massachusetts House and Senate on Tuesday.

The Massachusetts plan will provide free health insurance to all families below the poverty line, and provide partial subsidies to those making between 100% and 300% of the poverty level to purchase health insurance. Starting in 2008, all individuals will be mandated by law to purchase insurance -- with penalties equal to half the cost of health insurance if they fail to do so. While the state House initially proposed that businesses not currently providing health insurance would pay a fee equivalent to 5-7% of their payrolls for the program, that amount was reduced to just $295 per employee during negotiations with the state Senate.

Extending health care coverage to 500,000 uninsured residents and increasing the subsidies for lower-income families is an important advance in policy. But as currently structured, the individual mandate to purchase health insurance puts an unfair burden on struggling working and middle class families. Individuals should not face tax penalties of up to $1000 to enforce such a mandate, even as irresponsible businesses that fail to provide health insurance are required to pay only $295 per employee.

The broad-based Affordable Care Today! (ACT!) coalition endorsed the bill, although with reservations. As key health care advocate John McDonough wrote on his blog, the law will expand affordable coverage for hundreds of thousands of state residents with better cost control systems for existing health plans, but will dump too much of the costs on individual workers, leave too many costs on employers who do provide insurance for their employees and put too little responsibility on employers who don't.

The core problem with the law was that Governor Mitt Romney, running for the Republican nomination in 2008, developed the individual mandate part of the plan in collaboration with the rightwing Heritage Foundation, including its health staffers, Bob Moffit and Ed Haislmaier. The explicit goal was to undercut progressive alternatives such as expanding Medicaid to cover more of the uninsured or having employers take more responsibility for covering their employees. And Romney is trying to pitch the passage of the Massachusetts bill -- including its heavy burden on working families through the individual mandate -- as undermining the case for covering the uninsured through expansions of Medicaid or Medicare. "The old single-payer canard is gone," crowed Romney.

With more employers dumping health benefits -- an increasing and disturbing trend -- working families are unlikely to be thanking Romney for sticking them with the bill while doing almost nothing to require employers to pay their fair share of the costs for health insurance. In the meantime, single payer advocates and advocates for employers paying their fair share of health costs won't be emulating Romney's harsh individual mandate model in other states.

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FL: Leaving the Injured without Justice

The corporate lobby scored a big victory in Florida last week, as the Sun Sentinel detailed:

The Florida Senate gave final approval Thursday to a measure toppling a centuries-old principle of civil law that will make it harder for people to collect damages when they're injured in an accident.

The new law eliminates "joint and several liability", the principle that when a company negligently injures a person, they are responsible for the harm they cause, regardless of whether others also contributed to the harm. The traditional idea has been that the first priority is to make whole the victim. A particular wrong-doer is free to go to court to reclaim costs from others who might have also contributed to harm to the victim, but that relative apportionment of blame is irrelevant to whether the victim is made whole.

The new approach under Florida law is being sold as "fairly" assigning liability by assigning only a proportion of costs to any party harming a victim, but as Public Citizen outlines in this policy brief, it's all rhetorical sleight-of-hand to talk about a fair "portion" of the costs:

[A]n individual defendant's responsibility does not decrease just because another wrongdoer was also an actual and proximate cause of the injury...[I]mposing the full measure of that damage on an individual defendant is not unfair, as they have already been found to be fully responsible for the harm.

With joint and several liability, polluters for example can't as easily escape responsibility for their actions: "members of the community injured by these emissions can sue and collect the entire sum of damages from the corporate wrongdoers without proving the exact proportion of damage each corporation caused." Companies can sue each other to apportion blame, but that is left up to the guilty parties, not the injured plaintiffs, and if any of the companies go bankrupt, the doctrine of joint and several liability assured that the plaintiffs could collect their damages.

But under Florida's new approach, it's the guilty who will escape liability and the injured who will be left holding an empty bag when any wrong-doers declare bankruptcy.

While a number of other states have limited joint and several liability in recent years, there has been resistance in a number of states. In Illinois a few years ago, the state Supreme Court struck down a package of business-backed restrictions on tort damages, including limits on joint and several liability, as violating the state constitution. And Pennsylvania Governor Edward Rendell just last week vetoed a bill similar to Florida's that would have limited joint and several liability in that state.

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Anti-TABOR Forces Get Boost From Maine Court

In states across the country, the far-right is pushing "TABOR" measures based on Colorado's now infamous spending cap. The Colorado model that capped spending increases at a rate equal to population growth plus inflation and that ratcheted down spending in recession years, is now being largely eschewed by the right following voter rescindment of the awful legislation in Colorado.

But multiple states will still see initiatives that cap growth in government spending using the same population growth plus inflation formula that has failed before. But voters in Maine are likely to have a bit more time before considering this radical attempt to stealthily slash government thanks to a court ruling that TABOR advocates failed to gather enough signatures by the state-mandated deadline.

While the proponents of the Constitutional Amendment are appealing, arguing that a broad reading of law that "protects" voters includes counting signatures that don't meet legal requirements, opponents of the measure are making it clear that they intend to fully educate the public in Maine about the dangers of TABOR.

TABOR's history in Colorado is awful. As the Center for Budget and Policy Priorities made clear, TABOR resulted in devastating budgets for K-12 Education, Higher Education, Public Health, Insurance, and infrastructure. The end result? A budget system so awful that "[a] wide range of Coloradoans -- business leaders, higher education officials, children�s advocates, legislators of both parties, and Governor Bill Owens (R), among others" -- came together to demand change to the system.

More Resources

More Resources

The Massachusetts Health Care Model: Expanded Coverage with a Heavy Burden on Working Families

Progressive States: LegAlert -- State Health Care Models
AFL-CIO: Fair Share Health Care Campaign
Massachusetts Health Care for All
Physicians for a National Health Care Program

FL: Leaving the Injured Without Justice

Public Citizen: Joint and Several Liability: A Common Law Doctrine Worth Saving
Commonweal Institute: The Attack on Trial Lawyers and Tort Law
Academy of Florida Trial Lawyers: Joint and Several Liability

Anti-TABOR Forces Get Boost from Maine Court

The Bell Policy Center (CO Think Tank): TABOR
Center for American Progress: TABOR
Center on Budget and Policy Priorities: TABORs and State Spending Limits

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Eye on the Right

As we note in our lead story today, Governor Mitt Romney worked closely with the Heritage Foundation to craft Massachusetts' health care legislation. That isn't too surprising, as Heritage is at the heart of the rightwing movement, having served as a bastion since 1973 as the go-to place for shoddy research advancing school vouchers, missile defense, and trickle down economics. As with much of the right, Heritage is a "think tank" that operates as little more than a tax-exempt lobby for its donors, including Johnson & Johnson, GlaxoSmithKline, America's Health Insurance Plans, Bristol-Myers Squibb Foundation, Pfizer, and PhRMA and other corporations totaling $1.98 million in 2004. Whose interests do you think they were advocating in Massachusetts?


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Matt Singer
Editor, Stateside Dispatch