Massachusetts Health Insurance Law Focus Of Debate Among Presidential Candidates

Main Category: Health Insurance / Medical Insurance
Article Date: 20 Nov 2007 - 5:00 PDT

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The recently implemented Massachusetts health insurance law, which requires all state residents to obtain coverage, "is now at the center of disputes" in the Democratic and Republican presidential campaigns, the Washington Post reports. The law, signed last year by Republican candidate and former Massachusetts Gov. Mitt Romney, requires all state residents to obtain health insurance this year or face possible tax penalties after Jan. 1, 2008, with subsidies for lower-income residents.

Democratic candidates Sen. Hillary Rodham Clinton (N.Y.) and former Sen. John Edwards (N.C.) have announced proposals to expand health insurance to all U.S. residents that would include an individual mandate. Democratic candidate Sen. Barack Obama (Ill.) has announced a proposal to expand health insurance to all residents that would not include an individual mandate. However, the debate on individual mandates among Democratic candidates "is in some ways overstated" because all of their health care proposals "are likely to be changed dramatically by Congress" and because the plans announced by Clinton and Edwards do not include enforcement mechanisms, according to the Post.

Among Republican candidates, the debate on individual mandates "is turned on its head," the Post reports. Romney, "while defending his plan in Massachusetts," has attributed the "more ambitious aspects" of the law to Democrats, and his presidential health care proposal would not include an individual mandate. Republican candidate and former Sen. Fred Thompson (Tenn.) has criticized individual mandates as a "tax penalty," and Republican candidate and former New York City Mayor Rudy Giuliani said that such requirements would move "you in the direction of socialized medicine" (Bacon, Washington Post, 11/18).

Study of Proposals
Health care proposals announced by Democratic candidates include potential benefits and risks for health insurers because they would increase the number of U.S. residents with private health insurance, as well as the role of the federal government in the market, according to a PricewaterhouseCoopers Health Research Institute study scheduled for release this week, the Wall Street Journal reports. The study found that the health care proposals announced by Clinton, Edwards and Obama would increase annual spending by about $100 billion annually, in large part to help more residents purchase private health insurance.

Benjamin Isgur, assistant director of the institute, said, "Here's the potential for a whole new pool of lives for them to cover, with payment behind it."

However, the proposals also include potential risks for health insurers, the "biggest of which might be a proposal ... that would set up a Medicare-like health plan that would compete with private insurers," according to the Journal.

In addition, under the proposals, the federal government could account for half of health care spending by 2011, six years earlier than currently estimated. According to the study, "Tipping past the halfway mark has broad implications for the industry, which will increasingly depend on government payment, which tends to be less than commercial payment" (Meckler, Wall Street Journal, 11/19).

Additional Developments
Summaries of several recent developments in the presidential campaign related to health care appear below.

• Edwards: Edwards last week in Milford, N.H., discussed his health care proposal and his differences with Clinton on the issue, the Pittsburgh Post-Gazette reports. Edwards said of health care reform efforts led by Clinton in the 1990s, "We had a Democratic president, a Democratic House and a Democratic Senate in 1993. We tried to pass universal health care. The drug companies, the insurance companies and the lobbyists killed it" (Sherman, Pittsburgh Post-Gazette, 11/18).
  
  
• Giuliani: Giuliani has criticized Democratic candidates for their support of "socialized medicine" and has "vigorously opposed expanding government health insurance for children," but his "current market-based proposals on health care ... have him campaigning against his own record in some ways," the New York Times reports. During his first term as New York City mayor, Giuliani took action to reduce the role of government in health care. However, after his recovery from prostate cancer during his second term, Giuliani began "one of the most aggressive efforts in the country to enroll children and adults in public health programs like Medicaid and Child Health Plus," the Times reports. As part of the effort, Giuliani promised to "root out the uninsured as he had rooted out criminals," according to the Times (Kershaw, New York Times, 11/17).
  
  
• Sen. John McCain (R-Ariz.): McCain on Saturday in Canaan, Vt., expressed support for the legalization of prescription drug reimportation from Canada and other nations with adequate safety standards, the AP/St. Petersburg Times reports. McCain said, "Drug companies and the lobbyists they pay in Washington want to keep your drug prices high. Obviously, I want them to be affordable." In addition, he said, "If we are going to control health care costs, we need to control the rising costs of pharmaceuticals" (AP/St. Petersburg Times, 11/18).
  
  
• Romney: Romney on Friday in Nevada discussed the Massachusetts health insurance law at the Las Vegas Chamber of Commerce roundtable, the AP/Ft. Worth Star-Telegram reports. Romney said that the law seeks to require state residents who can afford health insurance to purchase coverage, with subsidies for lower-income residents. He added, "My plan said this: Now that we got the rates down so they're more affordable ... either buy a health care policy or pay your own way at the hospital. But no more showing up expecting free care from the government or from the hospital" (Ritter, AP/Ft. Worth Star-Telegram, 11/17).
  
  
• Thompson: Thompson on Sunday in an interview with ABC's "This Week" said he supported efforts by the parents of Terri Schiavo to "keep that child alive" during a legal dispute over the issue in 2005, USA Today reports. Thompson, who last week received the endorsement of the National Right to Life Committee, said, "How can anyone come to the conclusion that there is a benefit of the doubt not to choose life for a loved one?" (Wolf, USA Today, 11/19).

Broadcast Coverage
ABC's "This Week with George Stephanopoulos" on Sunday included a discussion with Thompson about the Schiavo case and other issues (Stephanopoulos, "This Week with George Stephanopoulos," ABC, 11/18). Video of the segment and expanded ABC News coverage are available online.

CBS' "Face the Nation" on Sunday included a discussion with Edwards. The segment includes comments on an Edwards campaign advertisement about his health care proposal (Schieffer, "Face the Nation," CBS, 11/18). Video of the complete segment is available online. A transcript also is available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.