Posted on July 17, 2006

Massachusetts Health Care Reform Falls Short


By Rand Wilson and John Horgan
from Labor Notes, #328, July 2006

Frustrated by the lack of action on health care reform at the national level, activists are working for state-level reforms that could be models for a future, more sympathetic federal government.

Massachusetts recently gained national prominence when a reform bill was signed into law. Unfortunately, the “breakthrough” solution that has been trumpeted as reaching near universal coverage is a false promise.

Like most states, Massachusetts has a serious health care crisis. The number of uninsured is rising (state estimates are as high as 750,000 people), costs are the highest in the country, and bargaining for contracts is often stalemated over employers’ cost shifting demands.

Last year a number of large unions and the state AFL-CIO were drawn into a coalition that sought to expand coverage for the uninsured.

Although coalition allies believed in winning reforms that would improve the system, the coalition also included elite leaders from the private insurance industry, doctors groups, and hospitals.

This strange alliance meant that from the outset the coalition was committed to crafting a plan that would not upset the special interests most responsible for the current mess. (And for a little extra insurance, these special interest groups spent $7.5 million on lobbyists to make sure that the outcome of any reforms wouldn’t jeopardize their profits and power.)

Behind closed doors with top legislative leaders, the reform coalition’s leaders crafted a plan. It did make some modest gains by undoing cuts in state Medicaid programs that benefit the poorest people. And the largest pool of uninsured people—low-wage, often part-timer or temporaries —will be eligible for subsidized insurance plans.

However, the combination of an individual and employer mandate to achieve these gains has dangerous consequences. Under the legislation, employers with more than 10 workers who do not make a “fair and reasonable” contribution toward employee health insurance will only be required to contribute a fee of up to $295—per year.

The Massachusetts legislation has the potential to seriously erode employer-based coverage. In effect, it tells employers: pay $295 a year and let the taxpayers subsidize care for your workers.

But wait, it gets worse. If a company’s employee uses the state’s “free care pool” more than three times or its employees as a group use the pool more than five times a year, there is an additional “free rider”

This creates an incentive for employers to fire employees who use the free care pool and to hire only younger, healthier workers. It encourages employers to avoid hiring workers with health problems. It will discourage uninsured workers from seeking care and lead uninsured workers to pay out of pocket for care rather than risk applying for coverage from the free care pool.

Another downside of the bill is the “individual mandate” that essentially transfers the entire burden of paying for the uninsured to taxpayers and the uninsured themselves. It will require many working families to pay for coverage they simply cannot afford.

Finally, it pits families making over $60,000 — who are not eligible for subsidies, but are required to purchase insurance—against families that make less and are eligible for state subsidies.

By establishing a new public consensus that individuals are primarily responsible for health coverage, these proposals will make dropping coverage more acceptable. The public will be asked to fund subsidies for private insurance companies to offer low-cost insurance for low- and moderate-income adults. These plans will inevitably wind up being “catastrophic” health plans, leading to more personal bankruptcies.

To its credit, the state AFL-CIO issued a strong statement condemning the final bill and the national AFL-CIO provided a powerful written critique.

Jobs with Justice and other activists have been campaigning for a state constitutional amendment to make health care a right.

The campaign gathered more than 70,000 signatures to put the initiative on the ballot and won its first approval from the state constitutional convention in 2004. It needs another “yes” vote at a second constitutional convention to advance to the November ballot.

Anticipating a May 10 vote, over 200 supporters rallied outside the statehouse and delivered 2,500 postcards to legislators, but elected officials postponed the convention until July 12.

[To learn more about Jobs with Justice campaign, go to]

[Rand Wilson is a union organizer. John Horgan is a union steward at Verizon.]