Blue Mass Group

Reality-based commentary on politics.

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  1. Here it comes…

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    In addition, all state residents will be required to purchase or retain health insurance beginning July 1, 2007, as long as coverage deemed affordable is provide.

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    What if I don’t deem it affordable?  What if I want to not pay insurance.  Don’t I have that right?

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    We’ve been through these discussions on this forum before, and I suspect folks have already lined up on one side or the other.  I’m glad healthcare is expanded, and I’m glad cheap/free health care insurance will be available to the poor.  But, I don’t think it’s at all appropriate for the state to require that I enter into a contract with a private company.

    • if you don’t want to pay insurance (meaning if it’s truly “affordable”, whatever that means, but you choose not to buy it) then you have to pay for your own health care costs.  if you get sick and end up in the hospital, you just have to pay for it.  it’d be ideal if the state actually covered everything, or at least ran the health care system .. but if we don’t have that, it’s not fair for everyone else to be subsidizing those who “choose” not to pay into the health care system.

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      This is contingent of course, on affordability.  Which is very hard to define, and possibly impossible.

      • That’s what happens if you don’t have insurance in all 50 states now.

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        I tend to think that the state ought to provide minimal coverage for everybody, and then allow employers or individuals to aquire additional care insurance.  I’m not a doctor, so I have no idea how this should/could be implemented.

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        I’m just not at all happy about my government requiring that I enter into a contract with a private company — I think it oversteps the bounds by quite a bit.

      • WE have to pay for the health coverage of someone who chooses not to buy it but then needs it, if they can’t pay for it themselves.

        • that everyone who goes into a 7-Eleven has to buy a candy bar, because WE have to pay for the candy bars of someone who chooses not to buy it but then eats it, not paying for it themselves.

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          The issue isn’t pooling risk or reducing costs, the issue is the government forcing a private citizen to enter into a contract with a for-profit private company.  That’s a huge power grab by government, one that (to my knowledge) has never happened before, and one that’s ripe for exploitation and conflits of interest in the future.

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          Before you get started on car insurance, that’s different.  Why?  You don’t have to own a car.  In fact, I don’t; I’m not forced into entering a private contract with a for-profit car insurance company.

          • That’s like arguing that everyone who goes into a 7-Eleven has to buy a candy bar, because WE have to pay for the candy bars of someone who chooses not to buy it but then eats it, not paying for it themselves.

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            There are some key differences that destroy this analogy at its core.  In order of importance:

            1. Someone who steals a candy bar is committing a crime, and society’s response it to try to prevent them from doing so.  We don’t think it’s right.  But someone who gets sick or injured and goes to the emergency room… do you think society should respond by trying to prevent them from doing so?  Even if you want to live in a society like that, plenty of people don’t, and that makes it very different from the 7-Eleven analogy.
            2. Candy bars, and 7-Eleven, are not essential services like health care.  Choice is a much more important component when you’re talking about consumer commodities, than when you’re talking about health care (or access to the courts, or police protection)
            3. If 7-Eleven has a serious shoplifting problem and people feel their prices are too high because of it, they just shop somewhere else.  The cost isn’t pooled in the same way as health insurance; government is not involved.

            I agree with you that an individual mandate is a stupid way to do health care reform, and we should have the state provide a basic level of insurance for everyone, paid for from the general fund.  But I still think this analogy is completely broken.

  2. Section 60 of the act provides for approval of high deductible health plans (to satisfy the terms of the Federal Health Savings Accounts) only if there actually is a Health Savings Account.

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    I’m looking for more language, but this may cover the concern that many in the advocacy community had about the provision in the Senate bill that the Senators denied was even there.

  3. i’m curious if the individual mandate in this bill would be vulnerable to legal challenge. it’s hard to think of a precedent for compelling everyone to purchase a private company’s product (i.e. insurance policy).
    auto insurance is not really the same, as only those actually owning a motor vehicle and wishing to operate it on state roads is required to purchase it.
    i haven’t read the bill through, but are there penalties for those who cannot/do not purchase insurance?
    what do all of you lawyers think about the constitutionality of this mandate?

    • The mandate works as follows.  When you file your state tax return, you indicate whether or not you have “creditable coverage” (ie health insurance that meets certain requirements in the statute).  If not, and if the state determines that affordable coverage was available (based on regulations yet to be written) you will lose the benefit of the personal exemption on your tax return (i.e. you will pay a tax penalty).  There is an exemption for persons with religious beliefs incompatible with the purchase of health insurance (this probably is for members of the Christian Science Church). 

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      I doubt that any court would overturn the legislature’s ability to use tax policy in this manner, especially where tax  dollars are used to fund the uncompensated care pool.

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      Is it reasonable?  Is it fair?  As John McD points out, its all in the details.

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