The Health-Care Debate

The landmark plan, which went into effect in July 2007, requires that all Massachusetts residents obtain insurance from public or private agents. Low-income residents, defined as those who earn 300 percent of the poverty level or less, qualify for partial or total subsidies. People who earn more pay varying amounts based on their age, occupation, and location. (Under a prior state law, pre-existing conditions aren't considered a factor in determining what the insured will pay.) People can either sign up through their employers or purchase plans through the "Health Connector," a state-run vendor of private policies.

Before signing the bill, Romney vetoed several provisions, including one that requires businesses with more than 10 employees to offer an affordable insurance program and contribute toward employees' premiums or pay penalties. The Massachusetts legislature overrode his veto on that provision. But Mongan says Romney still made his point. "The governor, presumably with his eyes on the presidential race, did not want to support any additional taxes on employers." (The plan is not funded by a tax increase for residents, either, but by other sources of state revenue and federal funds.)

Since the plan aims for near-universal coverage, people who can afford insurance but don't sign up face losing a personal tax exemption. This penalty will increase sharply in 2009, from $219 per uncovered individual to almost $1,000 in some cases. But unsubsidized and some subsidized premiums remain far too expensive even for some middle-class residents, not to mention the working poor, says Stuart Altman, a health economist at Brandeis University, so it's unclear how they will manage.

Dianne Bridges, a self-employed graphic artist, is among them. She has put off getting insurance because she says the premiums designed by the state for her income level are too high and she finds it upsetting that the government would mandate people to purchase a private product and then penalize them for not being able to afford it. "I can't afford the insurance and I can't afford the penalties. I need to pay my bills," says Bridges. "Who do they the think they are to steal hard-earned money from me because I can't afford a specific product?"

Ron Norton, 47, earned almost $40,000 last year as an adjunct professor but doesn't get benefits at work. "When Gov. Romney unveiled the plan, he talked about $200-a-month policies," he says. But Norton would have to pay $234 for a high co-pay and deductible. A worthwhile plan would cost around $400, he says. "I can't be handing over this much money to an insurance company." He intends to start searching for a job with benefits.

Some of those who qualify for subsidized health care sound more positive about the plan. Security guard James Farioli, 61, of Springfield, signed up for Commonwealth Care last summer—just in time for heart surgery, which didn't cost him a penny. Because Farioli earns about $20,000 per year, his health care is completely covered by the state. Compared to the $413 per month he was paying for private insurance, the state plan is an amazing value. "I couldn't afford the [private] insurance. What little savings I had was depleted over health care," he says. "If it weren't for this health-care coverage, I'd be in trouble."