The Mandate and Massachusetts

Now that the Senate has managed to get the 60 votes needed to pass the so-called health care reform bill, it's the perfect time to consider how a government mandate to buy insurance, or face penalties, has impacted the state on which this insurance "overhaul" has been modeled.

The Massachusetts legislature, more than three years ago, passed what then governor Mitt Romney called "universal health care," a bill requiring state residents to carry health insurance if they can afford it and, if not, pay more in state income tax.

Companies with more than ten employees were henceforth required to provide a "fair and reasonable contribution" to the premium of health insurance for employees, or face penalties, with the employer getting to decide what the words "fair" and "reasonable" mean.

It would seem that, in Massachusetts, the state has passed along the responsibility for providing health care to the employer to the employee, thus essentially "privatizing" health care.

Utilizing a market connector concept in which people price shop from a buffet of private insurance companies, the Massachusetts measure is similar to one currently under consideration in the nation's capital.

As Massachusetts may be seen as the paradigm for the health care overhaul Congress is now contemplating, it might be useful to take a quick look at some of the changes that have occurred in that state since the measure was passed in 2006.

While the foreclosure rate in 2007, nationwide, was nearly 80% higher than it was in 2006, foreclosures just outside of Boston "nearly tripled from January through September compared with the same period" in 2006, according to Boston.com. Hundreds of tenants in foreclosed buildings were evicted, or faced eviction by mortgage companies with the greatest concentration of foreclosures in lower income neighborhood. In a state with an historically expensive housing market, area home auctions hit the roof.

When forced, by state law, to buy auto insurance, faced with unwieldy rent, and the escalating cost of food, the mandate to acquire health insurance may be seen as a strong contributing factor to the sharp rise in homelessness in that state.

Granted, Massachusetts is not among the top five states when it comes to foreclosure and mortgage default, but what was an evolutionary trend nationally produced a dramatic, sudden spike in the New England state.

And, importantly, two years after its legislature approved what a former Republican governor likes to call universal health care, the Boston Globe reported the number of homeless people in Massachusetts had reached an all-time high. The demand on the mortgage payer to make their auto insurance premium, pay off their credit cards, feed and clothe their family was only exacerbated by the additional demand of having to allocate a portion of their paycheck to meet their state's mandate for health coverage.

What's more, ironically, a plan that was intended to reduce the number of people turning to hospital emergency rooms instead drove them into homeless shelters, and hotels. When considering that the official unemployment rate in Massachusetts is at 8.9%, below the national average, one can only imagine the havoc a national mandate to carry health insurance will wreak on the rest of the nation.

Reportedly, too, the Romney health care overhaul, in Massachusetts, has increased rather than decreased the overcrowding in hospital emergency rooms.

So, while Massachusetts may now brag that 99% of its residents have some kind of health insurance, it would be prudent for members of Congress, and the president, to take a long, hard look at the state's housing market, and ask -- at what expense?

With an unemployment rate that is expected to grow in the foreseeable future, this is not the time to demand that Americans help shoulder some of the government's burden in covering the uninsured by requiring they carry health insurance, or be fined. It's essential to be perfectly clear that, now more than ever, there is a difference between universal health care, and a government mandate.

Any reform that includes a mandate is reform in name only, and may ultimately prove to accomplish little more than to drive people from hospital emergency rooms into homeless shelters.