Health care home run: Massachusetts' new universal health care law has everyone watching.

• Author: Feller, Megan

It's like the World Series for policy watchers: On April 12, 2006, the Bay State took a swing at universal health care. The game has just begun, but the crowd is excited.

Massachusetts passed legislation, by a large majority in both chambers, to create universal health coverage by 2009. It is not the first state to pass universal health legislation--that title goes to Maine--but it is unique.

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AN INDIVIDUAL MANDATE

The act's individual mandate--a first in the nation--caused a stir. The law requires individuals who can afford it to purchase health insurance--though it does not regulate what kind or how much--by July 2007. Beginning in 2008, citizens will provide insurance information on their tax forms or lose their personal deduction (about $180 to $190). In the years to follow, the financial penalty goes up. The definition of "affordability" has not yet been determined.

House Speaker Salvatore DiMasi called the individual mandate a "bold, positive and necessary step to achieve such a significant expansion of coverage." But he cautioned "it will only work if it is part of an overall package of shared responsibility. Individuals cannot be required to participate in a market that offers insurance products that are affordable but will leave them chronically underinsured.

"This reform proposal contains a carefully designed, combined approach of Medicaid expansion, state insurance subsidies, employer contributions to a healthy workforce, and a requirement for individuals to purchase insurance if it's affordable. With this balance, we will achieve universal coverage," claims DiMasi.

A SHIFTING OF FUNDS

Much of the reform re-distributes existing federal and state health money. The Uncompensated Care Pool will be replaced by the Health Safety Net Fund, still used to reimburse hospitals, but at different rates. As uncompensated care declines, funds will become available to subsidize insurance premiums for financially qualified people.

"This legislation re-directs subsidies away from big hospitals and health care institutions to the uninsured themselves. It's revolutionary," said Moffit.

To that end, the state will create the Commonwealth Care Health Insurance Program. It targets the uninsured who do not qualify for Medicaid programs but are unable to afford insurance in the private market. Ibis program subsidizes premiums on a sliding scale for individuals and families with incomes at or below 300 percent of federal poverty...