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
"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
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
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
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. …