The Health-Care Debate

Richard Kwan, 50, who is unemployed and on Commonwealth Care, said he's also pleased with the prescription benefits. "It's very easy to use," he says. "Overall the experience is great."

The number of people who have signed up for state-run subsidized coverage has exceeded the original estimates. Initially, the state figured on 135,000 people, says Dick Powers, a spokesman for Health Connector, but so far 169,000 have joined. As a result, the program may exceed its budget by almost $150 million in 2008. Yet only 16,000 more have signed up for the unsubsidized health plans, and almost 200,000 people remain uninsured—many of them near or below the subsidy threshold—in a program that was touted as "near universal."

Still, about 300,000 more Massachusetts residents are insured today than were covered in 2006. (In addition to the state plans, some are insured through federal programs like Medicare.) Businesses haven't balked at the fees or left the state, as some critics had warned. And insurance companies say that while they're not raking in significant profits, their bottom lines are edging upward.

"There was a big debate about whether it could be done," says Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation, a national health-care nonprofit. "Well, it's actually happening. It didn't blow up."

Whether it will be a good model for other states remains to be seen. At least nine other states, including Connecticut, Colorado and Iowa, have been considering universal health-care plans, and several others are aiming to at least cover children. But there are challenges in replicating the Massachusetts program, a state where most of the uninsured are young and relatively healthy. Also, the number of residents lacking insurance is much larger in some other states. In budget-strapped California, for example, where a similar initiative is being hotly debated, there are more uninsured people (roughly 7 million) than there are residents of the entire state of Massachusetts. Jamie Court, president of the Foundation for Taxpayer and Consumer Rights, a consumer advocacy group, believes the big premiums and limited benefits already evident in Massachusetts have diminished the chances of a similar plan being approved in California. "Massachusetts has proven to be not just a laboratory, but a mad lab. That's how we're looking at it in California," says Court.

Seven months in, it's still too early to draw any conclusions about the ultimate success of the Massachusetts experiment. Yet Romney continues to tout the plan on the national campaign circuit. Though he routinely characterizes it as "universal" and "private," in fact it has left a large swath of the population either uncovered or covered by state and federal funds. Though he says the plan didn't cost the state extra money, more people than expected have asked for subsidies—which could drive up the price tag. Yet in chatting with supporters after the New Hampshire primary, Romney put health care on par with his greatest economic achievements as governor. "We did get health care on track for all of our citizens in our state, balanced the budget all four years, and rebuilt our rainy-day fund," he said.

So far, his health care plan has not received that much scrutiny outside his adopted home state. But if his victory in Michigan helps propel him to greater heights in the race for the Republican nomination, his program could undergo a thorough examination.

With Sam Register

© 2008