Program January 2007 – Paths to Universal Health Insurance

Paths to Universal Health Insurance: Is Massachusetts a Map for Missouri?

A large crowd of Women’s Voicers listened intently as Sidney Watson, Professor of Health Law at St. Louis University’s School of Law, described how Massachusetts developed the nation’s first state-based plan to provide adequate, affordable health care for all its residents.

After years of advocacy work by Affordable Care Today (ACT), a statewide coalition of community and religious organizations, labor unions, doctors, hospitals, community health centers, public health advocates and consumers, the plan was brought to fruition last year through the efforts of political leadership that was both bi-partisan and experienced.

The plan includes private insurance premium assistance for low-income residents and the creation of private insurance purchasing pools for small groups and individuals. It also contains an individual mandate that requires people to buy affordable health insurance if it’s available. If they don’t, they must pay a penalty equal to 50% of the premiums. The mandate, however, doesn’t go into effect until such affordable insurance is available, creating an obvious incentive for the state to make sure that happens.

A big portion of the plan’s costs will be covered by funds that will no longer be needed to reimburse hospitals for the care of uninsured patients. Last year in Massachusetts, the state’s uncompensated care pool was one billion dollars.

Another critical piece is the state’s expansion of its Medicaid program to leverage as many federal dollars as possible. For every dollar the state spends on the program, the federal government contributes another two. To Watson, maximizing this stream of federal dollars is a no-brainer. “For a governor to do it any other way,” she says, “is just irresponsible.”

This led to a discussion of whether Missouri might be able to follow Massachusetts’s lead. Watson feels we can, although there are obvious hurdles, one of the highest being our state’s legislative term limits that work against the development of an experienced pool of lawmakers.

But the state has over 600 million dollars in uncompensated care costs that could be redirected, millions of additional dollars in untapped federal Medicaid funds, and surprisingly similar ratios of insured to uninsured as those in Massachusetts prior to their reform.

Watson is convinced, however, that no meaningful reform will occur in Missouri without a strong, grassroots advocacy coalition. She sees much hope here, with much already in place and with continuing support from the Missouri Health Foundation and new involvement from Community Catalyst, a national health care advocacy group that has strengthened efforts in several other states.

This grassroots advocacy is what Women’s Voices is all about. It’s time for us to roll up our sleeves and get to work!