Massachusetts Gets Universal Health Coverage

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Massachusetts looks set to pass legislation to guarantee universal health coverage—the first state to do so—and that should count as good news, even if the policy itself might have a few kinks in it. At first glance, the new law will require everyone to carry health insurance or face higher income taxes, provides subsidies for low-income workers (those making under $9,500 a year get free coverage), and levies a very small fine on businesses that don’t provide health insurance.

As with most things, the devil’s in the details. Matthew Holt has an incisive comment here—how this plan fares will depend on how the state regulates its insurers. If insurance companies are allowed to offer cheap policies to the healthy and unaffordable policies to the unhealthy, then the market will implode; those people forced to buy very expensive policies under the new mandate will simply end up underinsured, with all the risks that entails. Or perhaps insurance companies will be very heavily regulated (Massachusetts already requires community rating, which is good); we’ll see. Leif Wellington Haase also notes that funding issues, which have torpedoed many a state universal health care plan, could become an issue.

Ezra Klein says he would’ve preferred legislation that severed the tie between employers and the insured. That might be ideal, although now we’ll see once and for all whether individual mandates, which are often touted as a moderate alternative to single-payer or single-insurer systems, can actually work, and how well. There’s something unsettling about watching states “experiment” with various approaches to universal coverage—there are, after all, actual lives at stake here—but seeing as how the U.S. health care system is going to need a radical overhaul once someone who actually cares comes to office, it will be good to have evidence on which systems work and which don’t from as many states as possible.


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