Massachusetts appeared set to pass legislation yesterday to extend healthcare insurance to almost all of its residents, an accomplishment that has eluded policy-makers in Washington and the rest of the United States for decades.
Thelaw, whichonly awaits the signature of Governor Mitt Romney, will require citizens of the state to hold health insurance as of 1 July 2007. The governor likened it to current laws that make it illegal to drive cars without insurance. If the plan works, Massachusetts will be the first state in the US to achieve something at least very close to universal healthcare. Nearly all of the half a million or so citizens in the state without insurance should end up being covered.
"Massachusetts has set itself apart from every other state in the country," declared Governor Romney. He said the bill, approved on Tuesday by both sides of the state legislature, was "something historic, truly landmark, a once-in-a-generation opportunity".
President George Bush and his predecessor, Bill Clinton, both made ill-fated attempts greatly to expand health insurance care for the whole country, although from very different ideological angles. Early in his first term, Mr Clinton passed the challenge to his wife, Hillary, whose universal healthcare blueprint was famously thwarted.
The passage of the bill in Massachusetts, meanwhile, could prove a significant political boon for Mr Romney, a Republican and former business tycoon, who has been quietly positioning himself to make a run for the US presidency in 2008.
Negotiated over many months, the bill contains elements championed by both sections of the political spectrum. While there are provisions for subsidies and incentives for the poor and middle classes, some of its incentives also come in the form of penalties.
The key, noted John McDonaugh of the advocacy group Health Care for All, was that the approaches of Republicans and Democrats have been taken into account: "Instead of saying, 'Let's do neither', leaders are saying, 'Let's do both'."
A new state body will help the lowest earners buy policies that, with state help, will cost them nothing in premiums or other costs. Others living well above the poverty line but still unable to afford traditional policies will also receive help.
At the same time the bill envisages levying fees from private businesses with more than 10 workers that fail to provide health insurance for their payrolls. The fee would be $295 (£170) per worker per year. Meanwhile, individuals who fail to pay health insurance but are deemed able to afford it could face fines of up to $1,000 a year by the state.
Political leaders in the state's capital, Boston, claim the law will have only a minimal impact on the state budget, with a large chunk of the needed cash coming from the federal government. The huge cost now faced by the state in paying for emergency health care for the 500,000 uninsured should largely vanish.
"It's only fitting that Massachusetts would set forward and produce the most comprehensive, all-encompassing healthcare reform bill in the country," said Salvatore DiMasi, the House Speaker and a Democrat. "This is a very historic moment. We will be able to, in three years, hopefully, virtually insure every man, woman, and child."
Maine has come closest to meeting a similar goal of universal health care and comparable attempts have been made in Illinois and Hawaii. But no other state has gone so far as to make it a legal requirement for everyone to be insured.
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