Providing Health Insurance for All: What We Can Learn From Massachusetts

Karen Davis, PhD


April 28, 2006


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Massachusetts lawmakers recently passed historic legislation that would require all Bay State citizens to have health insurance. It also improves affordability of coverage so that this ambitious goal might be met.[1] This is certainly good news.

Any substantive effort to expand access to coverage is worthwhile, given the growing number of uninsured in this country and the large body of evidence showing the dangerous health implications of lacking coverage. [2,3] What Massachusetts has done holds potential lessons for every state. We urgently need a national solution to the problem of the uninsured, but states can lead the way and demonstrate feasible strategies.

The Massachusetts bill is grounded in the idea that individuals, employers, and government must share responsibility for health insurance.[[4]The bill includes an individual mandate that says that it is every person's responsibility to have coverage and to be able to pay for care when they need it. And while state legislators have vowed to override a provision, Governor Mitt Romney vetoed that requires firms with more than 11 employees to provide coverage or pay a per worker fee -- that doesn't take away from the broader legislative achievement.

It's important to be realistic. No other state might follow Massachusetts' lead, but this model might give other states ideas for shaping legislation on coverage that fits the needs of their populations[5]And it is critical that states take bold action soon -- for their residents' health, and for our health system, which can't provide high-quality care efficiently while millions are uninsured.

That's my opinion. I'm Karen Davis, President of The Commonwealth Fund.




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