Health-Care Reform: How Has the Individual Mandate Worked in Massachusetts?

Article excerpt

Six years into Massachusetts' version of health-care reform, most residents are complying with the individual mandate. But for some, the cost of a premium is almost prohibitive.

There was a moment some 5-1/2 years ago when Peter Kastner looked at his monthly health-insurance bills and wondered whether breaking the law might make more sense.

He and his wife were using a high-deductible plan with a $400 monthly premium, but it didn't comply with the landmark 2006 law that transformed health insurance in Massachusetts. Paying the tax penalty for not complying was almost more economical than the policies he found through the state-run insurance exchange program.

After three months, the Kastners decided that the risks associated with catastrophic insurance were too much, and they opted for coverage through his former employer at $800 a month. When that coverage ran out, monthly premiums under a new, state-approved policy jumped: By December 2009, their Blue Cross Blue Shield premiums were $1,125, then leapt to $1,425 in 2010. They now stand at $1,806.

"It's unaffordable, it's ridiculous, and it's absurd," says Mr. Kastner, a technology consultant in his mid-60s who lives in Westport, Mass. "I can't wait for us to get on Medicare."

Kastner's complaint illustrates the enormous uncertainty over the Affordable Care Act now that the US Supreme Court has cleared the way for its 2014 start date. For many, the linchpin of the law - the mandate that individuals obtain health insurance - is also the focus of the greatest doubt: What if getting health insurance just isn't economical?

In Massachusetts, the rough idea behind the individual mandate is that having more healthy people paying for insurance will help defray costs for unhealthier people to have insurance. It should also pay for other insurance requirements such as covering preexisting conditions.

State data show that since Republican Gov. Mitt Romney signed the law, 439,000 more people, out of a state population of 6.6 million, have signed up for insurance. Having the highest rate of insured individuals in the country is now touted by state political leaders as having clear economic benefits.

"Massachusetts health-care reform has become a competitive advantage, attracting young people and entrepreneurs who know they can come here and take a chance on a new company and still have access to the best care in the world," Gov. Deval Patrick, a Democrat who succeeded Mr. Romney, said after the Supreme Court issued its decision on June 28.

Even before the law took effect, more than 90 percent of Massachusetts' eligible population had some coverage. And polls show a solid majority of residents consistently supporting the law over the years.

In Texas, by contrast, about 27 percent of residents do not have insurance, the highest share in the country. Texas Gov. Rick Perry (R) announced this week he would refuse to expand Medicaid or set up an insurance exchange to help consumers shop for policies.

The Affordable Care Act "is a really, really good deal for places like Texas that have historically not provided good access for its women, children," says Robert Greenwald, director of Harvard Law School's Center for Health Law and Policy Innovation in Boston. …