House Unanimously Passes Health Care Cost Control Bill

Legislation encourages the use of electronic health record systems, rewards doctors who provide patient-centered care

BOSTON – The House of Representatives unanimously voted to move the Commonwealth into the next phase of health reform with legislation aimed at curbing health care costs and improving the overall quality of our health care system.

“With this bill, Massachusetts will once again be a national leader in health care reform. Our efforts to curtail costs and promote a higher standard of care will raise the quality of life in the Commonwealth and raise the bar even higher for states that seek to emulate the success Massachusetts has had with comprehensive health care reform,” said Representative Barbara L’Italien (D-Andover).

“The success of our landmark healthcare law presented the Commonwealth with a new challenge: to keep health care costs manageable, and also maintain our commitment to quality care with an ever-growing pool of insured residents. Today, the House has taken a meaningful step to address those challenges by unanimously passing legislation that will help rein in costs and deliver high-quality care to the people of Massachusetts,” said House Speaker Salvatore DiMasi (D-Boston).

“Massachusetts has taken meaningful steps to achieve universal health coverage but we will not fully realize that goal until we find a way to control costs and increase access to providers,” said Representative Patricia Walrath (D-Stow), Chairwoman on the Joint Committee on Health Care Financing. “This bill lays the foundation for serious cost-containment and contains targeted methods of increasing the health care workforce and enhancing the overall quality of care.”

To increase quality in the current health care system, the bill requires uniform coding of medical claims to simplify and make the billing process consistent and also creates a special commission on health payment reform to bring together public and private payers and providers to make recommendations to reform the way payments are made.

The bill also would require MassHealth to establish a Medical Home program that rewards primary care physicians for providing patient-centered, coordinated care with a focus on patients with chronic illnesses.

The legislation creates a streamlined structure to oversee implementation of a statewide electronic health record system by 2015 and creates a grant program to help physicians obtain and implement e-health systems. Doctors who receive grants would be required to report on quality measures they undertake in order to ensure they reduce duplication and enhance quality of care.

The bill also establishes new licensure requirements for hospitals and physicians contingent upon adoption of e-health records and computerized prescriptions order entry.

The legislation mandates that pharmaceutical companies establish and disclose a marketing code of conduct that responsibly informs the prescribing practices of physicians.

It also requires that the Department of Public Health post information on its website concerning each company’s compliance with the requirement.

Under the bill, pharmaceutical companies would be banned from purchasing confidential prescription drug information for marketing purposes and also directs the Department of Public Health to implement an outreach and education program to provide objective education to physicians to encourage evidence-based and cost-effective prescribing practices.

The bill also:

• Creates a Health Care Workforce Center within the DPH to examine critical access needs to make systemic changes that will expand the health care workforce, especially in underserved areas of the Commonwealth.

• Requires the Division of Health Care Finance and Policy to hold annual public hearings concerning factors that contribute to cost growth among insurers and hospitals and the relationship between provider costs and health plan premiums.

• Creates a loan repayment program for medical school graduates who commit to practicing primary care medicine in underserved areas of the Commonwealth.

• Requires hospitals to report data on hospital-acquired infections and serious reportable events as a condition of licensure and encourages hospitals to establish patient and family advisory councils to improve communications.

State Offers Program to Parents with Autistic Children

By Edward Mason
Staff writer
Eagle Tribune

BOSTON – The Massachusetts Department of Mental Retardation is accepting applications for parents of autistic children to join the state’s three-year autism waiver program.

The DMR will accept the applications Nov. 5 through Nov. 16. Eighty low-income children from across the state will be selected through a lottery to receive a waiver for up to $25,000 in benefits.

To be eligible, a child must have a confirmed diagnosis of an autism spectrum disorder. Those include autistic disorder, Rhett’s Syndrome, childhood disintegrative disorder and Asperger’s Syndrome.

The child also must be under 9 years old, a Massachusetts resident, eligible for MassHealth and able to be served safely in the community.

The waiver covers an individualized autism support care plan to help families determine their child’s needs and specific services.

There are an estimated 10,000 autistic children in Massachusetts. Rep. Barbara A. L’Italien, D-Andover, an autism advocate, said the program will help autistic children.

“All the research suggests if we get to children early on and give them support with education, communicating and managing their behavior, they have a much better chance of maximizing their potential,” L’Italien said.

Children selected through the lottery will be assessed for financial need and clinical eligibility.

To apply, parents from the Merrimack Valley, Cape Ann and the North Shore must go through the North Shore ARC at 6 Southside Road in Danvers. The telephone number is 978-777-9135, ext. 2301.

The waiver is a combination of federal and state matching funds. The state receives $1 million for every $2 million it appropriates. Right now, the waiver lasts just three years to ensure turnover so more children can participate. L’Italien said she hopes the state spends more money on the program in the future so more children can be eligible.

“My hope is that we’ll grow this program,” L’Italien said.

HOUSE AND SENATE REACH BUDGET ACCORD

BOSTON – Members of the Massachusetts Senate and House of Representatives appointed to resolve differences between the branch’s blueprints for the $26.8 billion Fiscal Year 2008 general operating budget have reached an agreement. The accord, known as a Conference Committee Report, was signed by all Democratic and Republican committee members and will travel to the Governor’s desk for his consideration after being accepted in both the House and Senate. The plan calls for an overall increase in appropriations of 4.2% over last year.

“This budget directs resources to proven initiatives that improve quality of life, stimulate and protect regional economic growth and ensure that the most vulnerable citizens receive the care they deserve. The Legislature has continued its commitment to supporting municipalities and strengthening the partnership between state and local government by focusing on core services such as education and public safety. Finally, the course this budget sets for the Commonwealth places it on solid fiscal ground by calling for appropriate savings and judicious spending on the most effective programs,” said Representative Robert A. DeLeo (D-Winthrop) and Senator Steven C. Panagiotakos (D-Lowell), who chair the House and Senate Committees on Ways and Means, respectively, and who were their branch’s chief budget negotiators.

In addition to Chairman DeLeo and Chairman Panagiotakos, the conference committee appointed by House Speaker Salvatore F. DiMasi (D-Boston) and Senate President Therese Murray (D-Plymouth) also included House Ways and Means Vice-Chair Marie P. St. Fleur (D-Boston); Senate Ways and Means Vice-Chair Steven A. Tolman (D-Brighton); ranking Republican House Ways and Means member Viriato M. deMacedo (R-Plymouth); and ranking Republican Senate Ways and Means member Michael R. Knapik (R-Westfield).

Selected highlights of the budget agreement include:

Local Aid

Provided $935 million, a $15 million increase, in Lottery aid to cities and towns which is due to the Legislature’s recent “uncapping” of Lottery Distribution funds allowing for the return of 100% of Lottery revenue to cities and towns;

Provided over $3.72 billion for Chapter 70 education funding, which is a $220 million increase over last year’s allocation. This amount is $93.4 million above the amount required under current statute to keep each school district at “foundation” levels and provides all 351 cities and towns with an increase in funding;

Provided $23 million for the Sewer Rate Relief fund to help control the water and sewer bills of ratepayers throughout the Commonwealth;

Provided $21.35 million in community policing grants to cities and towns;

Level funded the Additional Assistance line item;

Increased to $28.3 million Payment in Lieu of Taxes (“PILOT”) payments which represents a $3 million increase over last year; and,

Provided an increase of $2.8 million for regional school transportation reimbursements.

Education

With respect to Early Education and Care: Provided $166.9 million for child care vouchers for those being served by the Department of Transitional Assistance; $209.8 million for low income child care vouchers; and an additional $12.6 million for supportive child care to ensure that no children with active abuse or neglect cases will be without child care services;

With respect to the Department of Education: Provided $33.8 million for kindergarten expansion grants which represents a $6.8 million increase over Fiscal Year 2007; $58.3 million for regional school transportation; an increase for the special education ‘circuit breaker’ program of $12.3 million which represents a 9.49% increase over last year; and provide $13 million, up from $6.5 million last year, for Expanded Learning Time Grants; and,

With respect to Higher Education: Provided an increase for the scholarships of $4 million to allow a greater number of students to receive additional aid as the cost of higher education continues to rise; established the Commonwealth Covenant Fund, a new $3.75 million loan repayment program to encourage students to pursue degrees in math, science, engineering, technology and health care and to work in Massachusetts; provided an increase of $23.5 million for state and community colleges; and provided an increase of $25.2 million for the University of Massachusetts system.

Public Safety

Provided $4 million in funding for municipal police training grants;

Provided $500,000 for the witness protection board to protect those testifying in criminal prosecutions;

Provided over $160 million for services at the Department of Youth Services (DYS);

Provided $3.3 million for teachers’ salaries to improve teacher retention at DYS;

Provided $15.2 million for the State Police Crime Lab;

Provided $1.2 million to reduce recidivism rates at the Department of Corrections;

Provided $2 million for the youth anti-violence initiative, a multi-faceted approach to confronting teen violence; and

Provided $250,000 for an emergency text messaging notification system to be set up on all public college and university campuses.

Health and Human Services

Provided the Department of Mental Retardation with $1.3 billion representing a $51 million increase over the last fiscal year;

Provided the Department of Mental Health $667 million representing an increase of $19 million over last year;

Provided $799 million for the Department of Social Services;

Provided $3.3 million for expansion of single occupancy units for homeless individuals with mental illnesses;

Provided $9 million for adult mental health services;

Provided $23 million for salary adjustments for human service providers;

Provided an increase of $12 million for the Universal Immunization program to target Rotavirus, Meningococcal conjugate 4 (MCV4) and other existing immunizations;

Provided an increase of $8.5 million for tobacco control; and,

Doubled the appropriation to $1.2 million, from $600,000, for the Housing First pilot project.

Economic Development

Continued funding for the Commonwealth’s One-Stop Career Centers and increased funding for the Youth-at-Risk program by $2 million;

Increased the Massachusetts Office of International Trade and Investment by $500,000 over last year; and,

Provided $1.5 million for the Office of Business Development.

Housing and Homelessness

Provided $15 million in additional funding for Local Housing Subsidies to provide safe and affordable housing for low income and homeless families;

Provided $2.5 million in additional funding for the Massachusetts Rental Voucher program (MRVP) to continue to pay for existing vouchers to eligible families and individuals; and,

Provided an additional $100,000 for the funding for the Individual Development Account (IDA) program which pools state, federal and private funds to match earned income deposited into the savings accounts of qualified participants.

Veterans

Provided $18.1 million for annuity payments to certain veterans and their families; and

Provided $15.1 million for veterans benefits payments to indigent veterans.

House Brings Municipal Relief for Property Taxes Through Significant Health Care Savings

BOSTON – State Representative Barbara L’Italien (D-Andover) today announced that the House of Representatives approved by a near-unanimous margin a bill granting significant financial relief to cities and towns across the Commonwealth by allowing municipalities to enroll workers in the state health insurance system.

The savings for communities, estimated at between $120 million and $180 million per year, will significantly help communities reduce their reliance on the property tax. The bill, approved by the House in a vote of 149 to 1, proposed and developed by House members over the last two years, will be followed by further relief for communities with proposed changes to the investment of local pension funds.

“Our cities and towns need help and this is a bold reform that gives communities the tools to, in some cases, literally save millions of dollars each year – money that can be used to relieve the burden on property owners,” said Representative L’Italien. “I am hopeful that our communities will quickly adopt this important reform.”

Municipal health insurance costs have been rising at unsustainable rates, and many communities have been hard-pressed to meet the yearly escalating costs which now represent a disproportionate share of the overall bottom line.

The bill, “An Act to reduce the reliance on property taxes through municipal health care,” seeks to offset escalating municipal health insurance costs by allowing communities to enroll in the state Group Insurance Commission (GIC). By creating a new local option for municipalities to purchase their health insurance through the GIC, employees will now be able to subscribe to a potentially better plan than they now have and enjoy substantial savings on the superior coverage for them and their families. The legislation now proceeds to the Senate for its consideration.

A community-by-community breakdown for municipal costs and increases dating back to 2001 compared to state increases in that period is available online at http://www.mass.gov/Ador/docs/dls/mdmstuf/MunicipalActualExpenditures/insurancegic0106.xls.

“The members of the House should be proud of their important contribution to cities and towns and, hopefully, local officials will now provide much-needed tax relief with these savings,” said House Speaker Salvatore F. DiMasi. “Cities and towns need to first look at efficiencies and cost savings before we turn to the taxpayers.”

“This is one of the most meaningful, efficient and progressive things we in the House will ever do for municipal finance,” said Representative Rachel Kaprielian (D-Watertown), the lead author of the proposal. “The GIC is one of the best-designed, most comprehensive plans of its kind and, as an added bonus, its cost increases average about half of those in municipalities. The savings will be significant for many communities.”

New Law Will Help Pay for Artificial Limbs

New law will help pay for artificial limbs

By Ana Rivas
Salem News

BOSTON – When Juliet Bryce lost her leg in a car accident in Salem in 2001, she discovered that the amount her insurance company would pay wouldn’t cover the cost of the artificial leg that she needed.

Last year, when she had her prosthesis fixed after she lost weight from her first pregnancy, she made the same upsetting finding.

“You never fully understand the details of a policy until you have to go and make a claim,” Bryce says. “Then you discover you really didn’t have any coverage.”

But now a new law requires all health plans to provide coverage for prosthetic limbs, without annual spending limits, and it’s making a difference in the lives of real people.

“Now everyone is covered evenly,” Bryce says.

The so-called “prosthetic parity law” will ensure that Massachusetts residents who are paying for health insurance will receive the same prosthetic care provided under federal Medicare laws, said Steven Sosnoff, manager of Hanger Prosthetics & Orthotics in Worcester.

Rep. Joyce Spiliotis, D-Peabody, introduced the bill, backed by Rep. Barbara L’Italien, D-Andover, and Sen. Bruce Tarr, R-Gloucester.

When Gov. Mitt Romney signed the bill on Sept. 7, Massachusetts became the fifth state to enact such legislation. The new law will take effect in January.

“The emotional impact of losing a limb can be devastating,” Sosnoff said. But “most people do not learn of the devastating financial impact until they are in the midst of dealing with limb loss.”

Some insurance plans limited coverage to $750 or $1,500 per year, while a prosthetic limb can cost between $10,000 and $40,000, he said. And amputees need a new limb every three to four years on average, he explained.

Keith Cornell, a Salem prosthetist, was one of those who worked with the Mass. Society of Orthotists and Prosthetists to push for legislation to compel health insurance providers to cover the costs.

The need for such help is rare, he pointed out. “Approximately.0.000496 percent of the general population will yearly require new or replacement prosthesis,” Cornell said – meaning the new law will benefit just around 14 people every year.

Why is this law so important if it benefits so few? Because to those few, he said, it can be all that matters.

“We’re not talking about a car or vacation, but a very necessary part of existing normally,” said Theresa Arnold of Gloucester, who uses a prosthetic leg.

“What this bill passing means for me personally is not having to dish out $30,000 or $40,000 for my next limb, but a reasonable percentage instead.”

Arnold pays more than $1,000 a month for health insurance, but she found out it was terrible in terms of “durable medical equipment” or prosthetics.

“If people are equipped with adequate prosthetics,” Arnold said, “then they can live normal, healthy and productive lives.”

Romney signs bill to encourage in-home care for elderly

Bill Championed by Tucker, L’Italien 

By Edward Mason and Zach Church
Staff writers for Eagle Tribune

Yoram and Barbara Shahar of North Andover are more than a decade away from making the hard choices that come with retirement. One choice they do not want to make is having to go into a nursing home.That is why they approve of a bill championed by two local lawmakers and signed into law by Gov. Mitt Romney yesterday, which allows Massachusetts elderly and people with disabilities to obtain state help to live at home rather than a nursing home when they can no longer care for themselves.

The bill allows the state Medicaid program to pay for that home-based care. Previously, the Medicaid program, called MassHealth, paid mainly for nursing home care.

Andover Democrats Sen. Susan Tucker and Rep. Barbara L’Italien helped write the law and guide it through the Legislature.

At yesterday’s bill signing, they talked about how it gives seniors and people with disabilities control over their lives and the ability to live with dignity.

“The No. 1 issue in the mind of seniors is what will happen to me if I can no longer care for myself,” said Tucker, co-chairman of the Legislature’s Committee on Elder Affairs. “The No. 1 answer is they fear going off to a home.”

“The law signed today backs up the assertion that every person has the right to determine where they’d like to live,” L’Italien said.

Barbara Shahar, 51, agrees with L’Italien.

“I think it’s appropriate we do more for senior citizens,” she said. “Compared to a lot of other countries, we don’t do enough for our elderly.”

To the Shahars, the new law is about “options.”

“As we all know, when you get to that age, you are often on a fixed income,” she said. Her husband, Yoram, 52, observed that many people may not need the comprehensive care that comes with nursing homes.

“People are working out. They’re eating healthier,” he said.

Elliot Aronson, 70, of Andover shudders at the thought of having to go into a nursing home.

“I would never want to leave my house,” said Aronson, who has forgone retirement to continue work as an attorney in Methuen.

Aronson said he is doing all he can to keep fit so he can always live at home regardless of the new law. But he said the new choice is a good one for others.

Under the law, seniors and people with disabilities who qualify for MassHealth long-term care coverage would be told they have a choice of home or nursing home care. They would then have their physical and mental health assessed to determine whether they can live at home.

If they don’t need intensive nursing home care, MassHealth would pay for them to live at home and have access to the same services provided by nursing homes. Those include personal care attendants, homemaker assistants, private duty nurses, day habilitation, adult foster care and medical transportation.

The law is expected to reverse an imbalance toward nursing home care.

“We have learned that a community-based approach to care delivery is cost-effective and that it honors the preferences of elders and people with disabilities to remain members of the communities that they helped to build for as long as possible,” said state Elder Affairs Secretary Jennifer Davis Carey.

MassHealth spends about $1.6 billion per year to care for about 32,000 individuals, or 70 percent of all nursing home residents. Choice proponents believe that could shift to a 50/50 split over the next decade.

It also is expected to bring Massachusetts in line with other states, like Oregon and Vermont, which are giving elders and people with disabilities more say in their long-term care.

Moreover, it should save the state money. MassHealth spends $52,000 a year to care for each nursing home resident. That is expected to be cut in half.

As part of the new law, people choosing in-home care also would be allowed to keep more of their own money.

The state wants to raise the MassHealth eligibility threshold for home care from $2,000 a month to $10,000 a month. The $2,000 current limit for nursing home care would remain the same.

Supporters of the bill described its passage as a matter of civil rights, insistent the state ought to offer equal opportunity for residents hoping to stay in their homes.

Some states spend half their long-term care budget on community-based care, double Massachusetts’ 25 percent – a figure Al Norman, executive director of Mass. Home Care, said would change incrementally.

“What we are doing today is helping to eliminate a form of discrimination in our land,” Norman said.

During his visits to senior centers, Norman said, he frequently asks for a show of hands from those hoping to enter nursing homes. “No hands ever go up. There’s a lot of nervous giggling.”

Although the law was signed yesterday, it is not yet clear when people will be able to benefit from its changes.

State Health and Human Services Secretary Timothy Murphy said the state first needs to get a Medicaid waiver from Washington to make the changes in the law. That waiver is due Oct. 1, 2006.

Material from the State House News Service was used in this report.

Bill Establishing Choice of Long Term Care Signed

Equal Choice Bill Signed

Seniors citizens and the disabled who quality for long term care services under the MassHealth program will have an “equal choice” of care at home, or care in a nursing home, under legislation signed into law.

Chapter 211 of the Acts of 2006 will do the following:

• Modernizes the MassHealth program from one which has historically been institutionally oriented, to one which focuses on care “in the least restrictive setting appropriate” to an individual’s needs.
• Will save state taxpayers $134 million in the first five years after implementation.
• Establishes a more focused “pre-admission counseling” program for people who are being referred to a nursing home, to ensure that they are aware of community alternatives.
• Calls for the state to submit a “waiver” to the federal government which will raise the income and asset levels for the MassHealth long term care program, thus allowing the Commonwealth to capture 50% federal match for some elders who are not fully supported with state funding.

House Passes Bill to Improve Hospital Patient Safety

State Representative Barbara L’Italien (D-Andover) announced today that the House of Representatives has passed historic legislation to improve patient safety in hospitals by limiting the number of patients a nurse can care for at one time and investing more resources in the nursing workforce.

H. 4899, “An Act Relative to Patient Safety,” creates a baseline of quality care for every patient in the Commonwealth. The compromise bill takes a responsible approach to protecting patients, nurses and hospitals by directing the state Department of Public Health (DPH) to establish limits – through flexible regulations – on staffing levels. Adjustments in nurse staffing assignments may be made according to the severity of patient illness, the skill mix of the entire nursing care team and other factors.

“This bill ensures that nurses will be given enough time to care for all of their patients, especially those with the most critical needs,” said L’Italien. “It will help reduce medical errors and assist our hospitals in attracting and retaining quality nurses.”

Under the legislation, teaching hospitals would be required to comply with the DPH staffing regulations by October 2008. All other affected facilities would have until October 2010 to meet the requirements. Hospitals experiencing an extreme financial hardship would be able to apply to DPH for a waiver of up to nine months.

The bill also invests heavily in the nursing workforce through the creation of new programs that help nursing students repay their loans, refresher programs for nurses already in the workforce and matching grant programs for hospitals that provide education and prioritization for nurse faculty positions.

Massachusetts Governor Signs Health Bill, With Vetoes

04/13/2006

Eagle Tribune

BOSTON – Gov. Mitt Romney signed into law yesterday a landmark health care bill designed to insure nearly all Massachusetts residents and set a national standard for other states to follow.Even as he signed the bill, surrounded by state and congressional leaders at a ceremony steeped in fanfare at Boston’s historic Faneuil Hall, Romney faced criticism for his decision to veto a key portion of the bill requiring all businesses that do not provide health insurance to pay a $295 annual fee.

The law, intended to require coverage for nearly all of Massachusetts’ estimated 550,000 uninsured, has thrust the state to the forefront of the national debate about how to provide near-universal health care coverage without creating a single government-controlled system.

It’s also a political coup for Romney as he weighs a potential run for the Republican presidential nomination in 2008. The law could be a centerpiece of that campaign if Romney can credibly claim spearheading a groundbreaking health care reform package.

Romney called the legislation a big step forward in health care reform.

“The reason this is so landmark is that we have found a way, collectively, to get all of our citizens insurance without some new government-mandated takeover or a huge new tax program,” he said. “Instead the money we’re spending on uncompensated care is going to be able to help people get insured and get the subsidy they need to buy that insurance they can afford.”

The many speakers at the ticket-only event attended by more than 300 people were quick to congratulate each other on the bipartisan effort. Romney and Democratic U.S. Sen. Edward Kennedy shared the same Faneuil Hall stage for the first time since Romney’s failed effort to unseat him in 1994.

“With the signing of this landmark health reform bill, after so many years of false starts, our actions have finally matched our words and we have lived up to our ideals,” Kennedy said. “You have given Massachusetts just what the doctor ordered.”

Besides the $295 per-employee fee, the law provides subsidies and sliding-scale premiums to get poor and low-income residents into health plans. Those deemed able to afford insurance but who still refuse would face increasing tax penalties.

An ABC News-Washington Post poll of more than 1,000 adults nationwide released yesterday found 55 percent of Americans would support a health care law similar to the Massachusetts model in their own states, with 41 percent opposed. The poll had a margin of error of plus or minus 3 percentage points.

Romney used his line-item veto power to strike eight portions of the bill, most significant the $295 fee. Administration officials say the fee could actually discourage registration for the new health program, since some employers might consider it cheaper to pay the fee than insure workers. Romney, in his veto, said it was not necessary to implement or finance the reform.

Leaders of the heavily Democratic House and Senate have said they would override any changes proposed by the governor.

House Speaker Salvatore DiMasi called the vetoes disingenuous, saying the law was crafted with concessions and compromise.

“To change anything will disturb the delicate balance that made this law possible,” DiMasi said. “Each and every element of this law is critical to accomplishing our intentions and goals.”

DiMasi said he wasn’t sure if the governor was issuing the vetoes “for purposes of making the bill work or making him look good politically.”

Business and hospital leaders also criticized the veto of the fee.

Massachusetts Hospital Association President Ron Hollander said the veto threatened the balance of the bill.

“I think it is important that all the parts and all the parties stay together,” he said. “The employer assessment is critical.”

Michael Widmer, president of the business-backed Massachusetts Taxpayers Foundation, called the $295 assessment “a fair compromise that reflected the fact that one group of employers were subsidizing the free care costs of another group.”

Romney, speaking to reporters after the event, defended his actions.

“There are many businesses who have been flooding my office with calls as well as business associations, that are very concerned about it,” he said. “I made it very clear to both the House and Senate that I didn’t believe the $295 made sense.”

The Rev. Hurmon Hamilton of the Roxbury Presbyterian Church said there are still big questions left unanswered by the bill. He said the one sour note in the hoopla-drenched event was the lack of poor people invited to the historic hall for the signing.

“What was missing from the picture was poor people and people of color, the diversity of the folks who ultimately will be affected and impacted significantly by the bill,” he said.

Besides the $295 per-employee fee, the law, which requires everyone in Massachusetts be insured by July 2007, provides subsidies and sliding-scale premiums to get poor and low-income residents into health plans. Those deemed able to afford insurance but who still refuse will face increasing tax penalties.

The first year, they will lose their ability to claim a personal exemption on their state tax returns. That would cost an individual about $189 and a couple filing jointly about $378.

The second year they will be assessed half the annual cost of one of the new low-cost health plans that are supposed to be created by private insurers under the bill – a fine that would easily top $1,000.

The plan is already drawing criticism from some who say the requirement that everyone have insurance, known as an “individual mandate,” is an unacceptable expansion of government power. Some small business owners have also blasted the $295 fee, saying it could force them to fire workers or make it harder for them to expand.

The legislation also fails to flesh out some of the grittier details of the plan, including just how inexpensive the new low-cost health plans envisioned by the legislation will be.

The cost of the health care package was put at $316 million in the first year, rising to more than $1 billion in the third year, with much of that money coming from federal reimbursements and existing state spending, officials said.

About $125 million in new money will come from the state’s general fund each of the three years. The $295 per-employee assessment would have brought in a maximum of $45 million a year.

Massachusetts Governor Signs Health Bill, With Vetoes

Published: 04/13/2006

Massachusetts governor signs health bill, with vetoes

Eagle Tribune

BOSTON – Gov. Mitt Romney signed into law yesterday a landmark health care bill designed to insure nearly all Massachusetts residents and set a national standard for other states to follow.Even as he signed the bill, surrounded by state and congressional leaders at a ceremony steeped in fanfare at Boston’s historic Faneuil Hall, Romney faced criticism for his decision to veto a key portion of the bill requiring all businesses that do not provide health insurance to pay a $295 annual fee.

The law, intended to require coverage for nearly all of Massachusetts’ estimated 550,000 uninsured, has thrust the state to the forefront of the national debate about how to provide near-universal health care coverage without creating a single government-controlled system.

It’s also a political coup for Romney as he weighs a potential run for the Republican presidential nomination in 2008. The law could be a centerpiece of that campaign if Romney can credibly claim spearheading a groundbreaking health care reform package.

Romney called the legislation a big step forward in health care reform.

“The reason this is so landmark is that we have found a way, collectively, to get all of our citizens insurance without some new government-mandated takeover or a huge new tax program,” he said. “Instead the money we’re spending on uncompensated care is going to be able to help people get insured and get the subsidy they need to buy that insurance they can afford.”

The many speakers at the ticket-only event attended by more than 300 people were quick to congratulate each other on the bipartisan effort. Romney and Democratic U.S. Sen. Edward Kennedy shared the same Faneuil Hall stage for the first time since Romney’s failed effort to unseat him in 1994.

“With the signing of this landmark health reform bill, after so many years of false starts, our actions have finally matched our words and we have lived up to our ideals,” Kennedy said. “You have given Massachusetts just what the doctor ordered.”

Besides the $295 per-employee fee, the law provides subsidies and sliding-scale premiums to get poor and low-income residents into health plans. Those deemed able to afford insurance but who still refuse would face increasing tax penalties.

An ABC News-Washington Post poll of more than 1,000 adults nationwide released yesterday found 55 percent of Americans would support a health care law similar to the Massachusetts model in their own states, with 41 percent opposed. The poll had a margin of error of plus or minus 3 percentage points.

Romney used his line-item veto power to strike eight portions of the bill, most significant the $295 fee. Administration officials say the fee could actually discourage registration for the new health program, since some employers might consider it cheaper to pay the fee than insure workers. Romney, in his veto, said it was not necessary to implement or finance the reform.

Leaders of the heavily Democratic House and Senate have said they would override any changes proposed by the governor.

House Speaker Salvatore DiMasi called the vetoes disingenuous, saying the law was crafted with concessions and compromise.

“To change anything will disturb the delicate balance that made this law possible,” DiMasi said. “Each and every element of this law is critical to accomplishing our intentions and goals.”

DiMasi said he wasn’t sure if the governor was issuing the vetoes “for purposes of making the bill work or making him look good politically.”

Business and hospital leaders also criticized the veto of the fee.

Massachusetts Hospital Association President Ron Hollander said the veto threatened the balance of the bill.

“I think it is important that all the parts and all the parties stay together,” he said. “The employer assessment is critical.”

Michael Widmer, president of the business-backed Massachusetts Taxpayers Foundation, called the $295 assessment “a fair compromise that reflected the fact that one group of employers were subsidizing the free care costs of another group.”

Romney, speaking to reporters after the event, defended his actions.

“There are many businesses who have been flooding my office with calls as well as business associations, that are very concerned about it,” he said. “I made it very clear to both the House and Senate that I didn’t believe the $295 made sense.”

The Rev. Hurmon Hamilton of the Roxbury Presbyterian Church said there are still big questions left unanswered by the bill. He said the one sour note in the hoopla-drenched event was the lack of poor people invited to the historic hall for the signing.

“What was missing from the picture was poor people and people of color, the diversity of the folks who ultimately will be affected and impacted significantly by the bill,” he said.

Besides the $295 per-employee fee, the law, which requires everyone in Massachusetts be insured by July 2007, provides subsidies and sliding-scale premiums to get poor and low-income residents into health plans. Those deemed able to afford insurance but who still refuse will face increasing tax penalties.

The first year, they will lose their ability to claim a personal exemption on their state tax returns. That would cost an individual about $189 and a couple filing jointly about $378.

The second year they will be assessed half the annual cost of one of the new low-cost health plans that are supposed to be created by private insurers under the bill – a fine that would easily top $1,000.

The plan is already drawing criticism from some who say the requirement that everyone have insurance, known as an “individual mandate,” is an unacceptable expansion of government power. Some small business owners have also blasted the $295 fee, saying it could force them to fire workers or make it harder for them to expand.

The legislation also fails to flesh out some of the grittier details of the plan, including just how inexpensive the new low-cost health plans envisioned by the legislation will be.

The cost of the health care package was put at $316 million in the first year, rising to more than $1 billion in the third year, with much of that money coming from federal reimbursements and existing state spending, officials said.

About $125 million in new money will come from the state’s general fund each of the three years. The $295 per-employee assessment would have brought in a maximum of $45 million a year.