Massachusetts plan afor health care hit

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BOSTON (AP) -- The most radical portion of Massachusetts' move toward universal health care -- a requirement that all residents carry insurance -- is giving indigestion to some who view it as a breathtaking expansion of government power.

"This is the first time in the country's history where simply by virtue of living somewhere you are mandated to purchase a product," said Michael Tanner of the libertarian Cato Institute, based in Washington.

Supporters of the idea, including Gov. Mitt Romney, a Republican, cite the mandate as a pillar of the health plan because it forces individuals to take responsibility for their health care.

Many conservatives are embracing the so-called individual mandate, but some liberals and unions are suspicious. They typically prefer assessments on employers, which the Massachusetts plan also includes.

AFL-CIO President John Sweeney called the mandate "unconscionable."

"Forcing uninsured workers to purchase health care coverage or face higher taxes and fines is the cornerstone of [former Republican Speaker of the House Newt] Gingrich's health care reform proposals," Mr. Sweeney said.

Mr. Romney and other supporters of the mandate say it spreads the burden of covering the uninsured among ordinary citizens, business and government. Mr. Romney is expected to sign the bill, though he may veto a $295-an-employee fee for businesses that don't offer insurance.

Mr. Romney, a possible candidate for the 2008 Republican presidential nomination, has compared the individual mandate to car insurance, which the state requires for everyone who owns a car. Massachusetts, under the bill, will also require everyone to have health insurance.

According to Mr. Tanner, that's a false comparison.

"Driving has always been seen as a privilege that can be revoked," he said. "This is making me buy a product simply by virtue of breathing."

What no one can say for sure is how many of the estimated 500,000 uninsured people in Massachusetts would be subject to the individual mandate -- in effect, how many earn enough to buy insurance but don't?

That, according to John McDonough of Health Care for All, a state advocacy group, is one of the complex bill's many unanswered questions.

"Whether it will work out or not, we don't know," Mr. McDonough said.

The bill, a dense 145 pages, is still in the works. Some of the grittier details, such as exactly what it means to be able to afford insurance, will be sorted out when the actual regulations are drafted.

Still, there are enough details to win over supporters and perturb opponents.

Under the plan, which would take effect in July 2007, everyone who files a state tax return, beginning in 2008, will have to indicate if they have health insurance.

The bill also requires Medicaid and private insurers to turn over to the state lists of their enrollees each month.

Anyone deemed able to buy insurance, but who is still uninsured, will face increasing penalties.