Health Reform Talks Stall Over Individual Mandate

March 28, 2006

Three weeks after declaring “The logjam that had been existing in the past is no longer existing" and one week after reporting last week that today would be "the latest" that the legislature would reach a final accord, healthcare reform "might still be far off," according to the State House News.

At issue is an individual mandate which would require all individuals to have health insurance, similar to the current auto insurance system for drivers. Yesterday Senate President Travaglini said “That’s exactly what the center of the delay focuses on - the definitions, when do you implement the penalties, when do you have an opportunity to evaluate the effectiveness and the success of the programs, are we going to realize a savings.”

Sen. Bruce Tarr (R-Gloucester) said he was optimistic that the conference committee would agree to a bill by July, but not optimistic that an accord would be announced in the coming weeks. “Everything is sort of on the table,” Tarr said in an interview during a long Senate recess on Monday. “It’s a long way from being resolved, this whole thing.”

The positions of the participants around an individual mandate are:

• Romney's first plan, stated that anyone who chose not to purchase health insurance would have to prove their financial footing by posting a $10,000 bond. Those who did neither would lose their personal tax exemptions, with offsets placed in an escrow account used to pay hospital bills. Residents in the lowest income brackets would still qualify for MassHealth.
• The House’s original individual mandate proposed an affordability test, with penalties for people who can afford insurance but opt not to purchase a plan, totaling up to half the amount they would have shelled out in premiums. Another clause in that legislation would prevent people who fail to pay the penalties within 60 days from renewing their driver’s licenses.
• Last month's Senate plan, after initially not including mandates, included the loss of the personal tax exemption and setting a pair of triggers tuned to the overall number of uninsured. If the total number were not halved by January 1, 2008, the mandate would go into effect; the trigger for January 1, 2009 would be 75 percent.

Underlying these issues are how expansion will be financed, the level of funding and how to adequately reimburse providers in an environment where more low income patients are underinsured and carry high copays and deductibles.

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