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The individual mandate is working in Mass.

Thus far, the individual mandate has been the dog that didn't bark in health-care reform. But unlike a lot of the more controversial policies in the bill, you could imagine it coming back in a big way later on. Bad implementation would create a political firestorm. Luckily, Massachusetts has been experimenting with how to make this work, and they seem to have it pretty near figured out. Lindsey Tucker rounds up the latest numbers from the state's Department of Revenue:

• Fully 98.3 % of tax-filers complied with filing health insurance information with their taxes. The 2008 filing required month-by-month determinations, as opposed to 2007’s requirement of Dec. 31 only.

• Over 96% of tax-filing adults who completed the Schedule HC had coverage at some point during calendar year 2008; almost 96% had coverage for the full year.

• 45,000 filers, uninsured and deemed able to afford insurance, were subject to a penalty—down 25% from last year’s 60,000 penalized.

• Insurance was unaffordable for about 21,000 (plus 88,000 under 150% fpl) individuals for the full year of 2008 and 24,000 individuals (plus 47,000 under 150% fpl) for part of the year.

• To date, the State has assessed $16.4 million in penalties, which will be deposited in the Commonwealth Care Trust Fund.

In other words, it's covering almost everybody, and fewer people are paying the penalty in the second year than in the first. Not too shabby.

By Ezra Klein  |  December 14, 2009; 8:20 AM ET
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Mass is broke and can't afford this anymore: From the local paper: In the wake of announcements made this week that Triton will cut 13 positions and teachers, state lawmakers are saying there isn't much that can be done.

Under Gov. Deval Patrick's "9C Authority" — cuts that the governor can make without approval by lawmakers — a cut to regional school districts will mean a $305,000 reduction in transportation reimbursements and $85,000 in special education transportation for the Triton School District.

In early November, to balance the state's budget, Patrick announced an $18 million cut to regional school transportation reimbursements.

Massachusetts General Laws require that when projected revenue is less than projected spending, the governor must act to ensure that the budget is brought into balance. State legislators voted to give Patrick authority in the fall. Since regional transportation falls under the Department of Education, Patrick was able to cut transportation reimbursements.

Education Secretary for the state, Paul Reville, said because of the tough budget season, decisions such as whether to cut regional school transportation reimbursements had to be made.

"We had to close a $600 million gap, and while education has been largely protected over the past two fiscal years from substantial reductions, everyone had to contribute to strategies we employed to present a balanced budget that matched spending with available revenue.

13 teachers 1 school district. We have hundreds of others that are facing the same cuts. Which are on top of the cuts they already made in the summer / fall.
We could use this money we're blowing on masshealth in the state.

Posted by: obrier2 | December 14, 2009 8:58 AM | Report abuse

Just out of curiosity- how much is the individual mandate there?

Posted by: spotatl | December 14, 2009 9:05 AM | Report abuse

So assuming that you're right, what are the odds that the U.S. Congress will produce a mandate as well-constructed as the Massachusetts state legislature?

Posted by: valeskoi | December 14, 2009 9:09 AM | Report abuse

Governor Deval Patrick announced last week he no longer plans to make $100 million in cuts aimed at addressing a deficit in the MassHealth budget. They can't even make the cuts they need to. You think the feds will? What about this? Six Massachusetts community hospitals are planning to sue the state for what they say are illegal cuts to Medicaid payments. The hospitals claim the unfunded mandates have resulted in significant financial losses and have prevented or delayed investment in capital projects, equipment and other updated healthcare resources for their communities.
The state is facing a near $3 billion budget shortfall in the next fiscal year, The looming deficit is caused by a series of factors, Gonzalez said. First, there is only modest growth in tax revenue expected for fiscal 2011 while at the same time the state is faced with "serious spending pressures" such as for Medicare, also known as the MassHealth program, debt service for bonds, and Chap. 70, which is state money doled out to cities and towns.

Posted by: obrier2 | December 14, 2009 9:36 AM | Report abuse


you cannot compare Mass. to say Alabama or Mississippi. What is a burden to one is different than the other and also what is the effect that a lack of income plays in it? The individual mandate really should have been regionalized for different parts of the country to tailor fit to their requirements as far as need/cost go. That's why I'd expect you're seeing an estimate of 94% from CBO as far as the future "insured" population goes.

also below is a link from the 2008 detailing the MA penalty and how it applies. Every year the penalty grows slightly to ensure it remains a penalty that keeps people insured. A cap of $750 if it stays there eventually will become a drop in the bucket compared to escalating costs.

Posted by: visionbrkr | December 14, 2009 10:21 AM | Report abuse

"***Governor Deval Patrick announced last week he no longer plans to make $100 million in cuts aimed at addressing a deficit in the MassHealth budget. They can't even make the cuts they need to.***"

Patrick made this announcement because of higher than expected revenue collections because of a recovering Massachusetts economy. In other words, they do NOT need to make these cuts, and quite sensibly reversed them.

Posted by: Jasper99 | December 14, 2009 10:30 AM | Report abuse

--"Not too shabby."--

It's amazing what you can do by threatening impoverishment, incarceration, or death to people with the power of government, ain't it, Klein? It's every wannabe's dream power trip.

Posted by: msoja | December 14, 2009 10:44 AM | Report abuse

msoja: "It's every wannabe's dream power trip."

Right-wingers do it all the time. That's why they're called 'Rethuglicans'.

As to the insurance scheme in Mass., my question would be what kind of insurance are these people getting? If you oblige people to get 'junk insurance', you're not really solving the problem.

Posted by: leoklein | December 14, 2009 10:51 AM | Report abuse

*_We_ could use this money we're blowing on masshealth in the state.*

I think the people who actually, you know, provide and receive health care, would say that _they_ could use the money.

Lots of states are facing budget crises, and states have to prioritize their spending. What's so important about your hobbyhorses?

Posted by: constans | December 14, 2009 11:06 AM | Report abuse

--"Right-wingers do it all the time."--

And that justifies... what?

Posted by: msoja | December 14, 2009 11:10 AM | Report abuse

"The individual mandate is working in Mass"

Umm...isn't the point of these things to get better health outcomes and improved financial stability for more people? Isn't *that* what health_care_ reform is supposed to deliver? The individual mandate, or any other strategy, has no value unless it does that.

The fact that the state can coerce people into buying insurance isn't equivalent to having a "working" solution. The measure of whether any particular reform strategy "works" is the degree to which it improves health outcomes and reduces medical debt.

So exactly has individual manadate improved the *health* of Massachusetts residents? I read a report a few months back that said that the percentages of newly covered residents who could not afford to get treatment after paying their premiums or who had incurred significant medical debt under the new program, were disturbingly high. We know that the Massachusetts experience has done nothing with respect to costs; do you have something that tells us about the health outcomes for those who have been required to buy insurance?

Posted by: Athena_news | December 14, 2009 12:00 PM | Report abuse


Why do you keep on peddling incorrect information on MA individual mandate?

You can't get something for nothing. Costs are ballooning in MA, busting the MA budget. Why do you think the folks there are considering global capitation?

Posted by: RandomWalk1 | December 14, 2009 1:13 PM | Report abuse

--The fact that the state can coerce people into buying insurance isn't equivalent to having a "working" solution.--

That's the inconvenient truth about Klein's recitation of Massachusetts politician's talking points (as also regurgitated by the NY Times and Boston Globe.) For the eternal petty despot (or despot wannabe, like Klein), success is measured in compliance, with short shrift being given to any of the more important factors like loss of freedom, waste of wealth, etc.

Klein's assessment of Cash for Clunkers was in exactly the same vein. Because thousands turned out "free" money, the program just had to be a success, despite the sagging sales that preceded and followed the program, despite the destruction of all those working clunkers, despite the resultant hike in used car prices and second hand parts, the increased debt forced on the public and voluntarily shouldered by those who bought new cars, etc.

It's what I call Valley Girl thinking, and it appeals to Klein's Valley Girl acolytes.

Klein is the face of a dumbed down populace, and a proud representative of the failing legacy media.

Posted by: msoja | December 14, 2009 1:34 PM | Report abuse

As always, nice try misleading public:

Here is the actual report and I will quote some numbers that may not look as rosy:

Chart 1: Details on Total Number of Tax Return filers (4,545,620 total)

Total Schedule HC filers = 3,946,490

Total Schedule HC non-filers = 599,130

So, that makes 13.2% of the Total number of Tax return filers not even filing the Schedule HC.

This is from the report:
"To date, 98.3% of tax filers required to file health insurance information with their tax returns have complied with the filing requirement."

.. and this is what you wrote above..

"Fully 98.3 % of tax-filers complied with filing health insurance information with their taxes."

Unless you're a dimwitted liberal you BS detector should go off now!

Posted by: darkskin1977 | December 14, 2009 2:49 PM | Report abuse

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