The Democratic alternatives to Romney’s proposal
The Democratic legislature, led by Senate President Robert Travaglini and House Speaker Sal DiMasi, was also working on a solution to the Medicaid problem. The House plan centered around a “pay or play” employer mandate, like the one that had been passed in 1988. Both the House and Senate plans dramatically expanded Medicaid, allowing the program to cover children in households making up to 300 percent of the federal poverty level (it had been 200 percent previously).
Simultaneously, a universal-coverage activist group called
Affordable Care Today was preparing a 2006 ballot initiative, that proposed to achieve near-universal coverage by increasing the cigarette tax and imposing an employer mandate.
Sen. Kennedy got involved, in order to help the House and Senate reconcile their differences, and Romney went to work trying to reconcile his own plan to that of the Democrats. Key areas of disagreement included the Democrats’ desire to expand Medicaid and force employers to cover their workers. All three plans contained an individual mandate, requiring every Massachusetts resident to buy insurance, and a Health Connector that would allow the uninsured to buy regulated, private plans.
The problem was, if they kept haggling over these important details, they risked not passing any legislation at all, and losing the $385 million in federal funds. In addition, there was the possibility that the left-wing ballot initiative plan, with no input from the legislature or the governor, would become law.
So Democrats passed their bill in the fall of 2005, and Romney signed it—with his various vetoes—in the spring of 2006. A few months later, Deval Patrick succeeded Romney as Governor of Massachusetts.
Romney individual mandate was designed to require catastrophic insurance
Romney’s big idea was to free insurers from the state’s costly 1996 insurance mandates, allowing individuals to buy inexpensive insurance that would meet their most urgent needs. But the health law he signed in 2006 did not specify the types of plans that insurers were required to offer. “The specific definition of [minimum creditable coverage under the mandate] was left to the board of the Health Connector to decide,” recounts Josh Archambault.
Romney’s goal, with the individual mandate, was to require people to buy catastrophic insurance that would cover emergency care. Romney’s version of the mandate was designed to compensate for the effects of the federal EMTALA law, that requires hospitals to provide emergency care to everyone, regardless of their ability to pay. “Therefore,” writes Archambault, “the original 2005 legislation filed by Governor Romney required that Massachusetts residents carry, at a minimum, catastrophic medical coverage, or in lieu of such coverage, a $10,000 bond…an approach that tracked the Commonwealth’s requirement for automobile insurance coverage.”
However, the bill that emerged out of the Democratic legislature contained a different mandate. The Democratic version did not restrict the mandate to catastrophic insurance, and it replaced the bond provision with a direct fine.
Furthermore, according to Archambault, when Deval Patrick assumed office, he populated the Health Connector board with progressives who favored mandating costly comprehensive insurance, instead of cheaper catastrophic coverage.
Romney favored expanded choice and cost-sharing; Patrick did not
Another example of the difference between the Romney and Democratic approaches was in the design of insurance options for middle-class individuals and small employers. “The Romney administration had envisioned an unsubsidized exchange program that provided small employers with a healthy defined contribution model,” writes Archambault. “The model’s goals were to move the current employer-based system to an individual purchase decision and encourage competition and consumerism.”
But that’s not what the Patrick administration implemented. Instead, Massachusetts’ “Commonwealth Choice” plan forced insurers to offer standardized “Gold,” “Silver,” and “Bronze” plans that were required to offer generous, comprehensive coverage, including mental health, substance abuse, rehab services, and vision care. Small businesses could only offer their employees plans from one of the three tiers, further limiting consumer choices. (This framework is also part of the federal Affordable Care Act.) DOES THIS SOUND FAMILIAR TO YOU
In the partially-subsidized system for lower-income individuals, the Romney plan sought to institute a degree of cost-sharing, so that individuals would have an incentive to avoid wasteful health spending. The Connector board, however, eliminated all cost sharing for individuals making less than 150 percent of the federal poverty level
