Universal health care law enacted in Massachusetts

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Gov. Mitt Romney yesterday signed a sweeping health care bill that will require every Massachusetts resident to be insured, a move that has divided conservative policy strategists.

The new law will set up a market-based universal health care system that will require everyone to carry a minimum level of insurance from a large number of private companies, enforced through the state tax return.

Premiums would be set on a sliding income scale beginning as low as $10 per week for the lowest income groups among the state's estimated 550,000 uninsured, with full subsidies for those who cannot afford it.

Mr. Romney says the plan will create a larger insurance risk pool that will lower premiums for all and offer broader consumer choices among private-sector products that will be "nearly 50 percent less expensive" than existing plans.

Everyone "must either purchase a product of their choice or demonstrate that they can pay for their own health care. It's a personal responsibility principle," he wrote Tuesday in the Wall Street Journal.

Others have compared the new law to state requirements that all drivers have auto insurance, laws that coexist with a free market in auto insurance.

But the ambitious undertaking, the product of months of negotiations in Mr. Romney's last year in office, would cost more than $1 billion a year and has drawn sharp criticism from conservatives who called it "a big government" plan and another version of "Hillarycare," the ill-fated plan produced in 1993 by first lady Hillary Rodham Clinton.

The legislation would be largely financed with the $1.2 billion that the state presently spends to provide medical care for the uninsured. It originally included a $295-per-worker tax on employers who do not provide health insurance, but Mr. Romney, who said the "fee is unnecessary and probably counterproductive," eliminated it, along with seven other provisions, with his line-item veto.

The Massachusetts plan has been the focus of a bitter debate among conservative domestic policy strategists -- pitting the Heritage Foundation, which supports much of it, against the Cato Institute, the Citizens' Council on Health Care (CCHC) and other free-market groups that said the program will impose more government controls, regulations and costs on people and businesses and violate their privacy rights.

"If Governor Romney signs this bill into law, a huge health care bureaucracy will descend on the people of Massachusetts. The 'universal coverage' bill mimics the vehemently opposed 'Hillarycare' legislation," said CCHC President Twila Brase.

"We often seem to believe bigger is better. What Americans do not love is bigger government -- that is unless you listen to Governor Mitt Romney and the Massachusetts legislature," the Council for Affordable Health Insurance said in a broadside attack on the plan.

Other critics pointed to the plan's large bureaucracy, trust funds and health care mandates that they argue will make its implementation inefficient and costly.

"It is loaded with individual mandates that have driven up the costs of health insurance in the first place. The numbers don't add up. The plan is going to be much more expensive" than its proponents have acknowledged, said Grace-Marie Turner, president and founder of the Galen Institute, which supports a free-market health system.

But Bob Moffit, Heritage's chief health care strategist, who has helped to create key parts of the plan, says the conservative think tank supports the bill's insurance reforms as an expansion of choice among employees no longer tied to their employer's policies.

"We are behind the insurance market reforms. We don't like the employer mandate parts, and we are not happy they did not deregulate the health insurance system in Massachusetts as much as we would like," Mr. Moffit said yesterday.

"What this plan does is replace the existing insurance market rules with a new market where individuals and families can buy health insurance and employers can define contributions. You pick what's good for you, and the employer makes a contribution to the plan of your choice," he said.

Mr. Moffit said the plan has triggered heated debate among conservative think tanks, but he denied it resembled Mrs. Clinton's plan.

"Read the bill. Hillary had a comprehensive standard benefits package, premium caps and price controls," he said. "There is division among conservatives. But there is a need for people to recognize that you are going to have to have trade-offs. This is Massachusetts where Democrats have a five-to-one advantage in the legislature."

"Will it work? I'm optimistic, but time will tell. A great deal will depend on the people who implement the program," Mr. Romney said Tuesday in a Wall Street Journal article.