Health Care Mandate Calls For Shared Responsibility

Celia Wcislo, assistant director of 1199 SEIU, United Healthcare Workers East, offers a reminder that reforming the health care system requires that individuals, insurers and providers all take on a share of the burden:

As Congress prepares to find consensus on the critical issues that will form the foundation of national health care reform legislation, many eyes are focused on Massachusetts and more specifically, on the individual health care requirement that was key to our success in expanding health care to the overwhelming majority of Massachusetts residents.

Both the U.S. Senate and House versions of legislation include a requirement that individuals who are economically able purchase health insurance. Though the language of the two bills is slightly different, the intent is similar to Massachusetts’s vision: individuals who face economic hardships are exempt from this requirement as well as any proposed contribution of their limited income. A health insurance mandate is not about punishing anyone; it’s about increasing participation and ensuring that everyone – individuals, government, and business — is doing their part. We have come to see it as a key part of our model of “shared responsibility.”

There are those who would like to frame this requirement as the beginning of the end of our constitutional protections and an express ticket to the slammer. This approach does nothing to educate Americans, business owners, or health care providers about the value of a health insurance requirement. And while labor and progressives were slow to embrace this idea originally, the health insurance mandate has truly helped to expand quality, comprehensive care to more Massachusetts citizens. And if done right, it could help improve the health of our nation.

Shared responsibility is the cornerstone: A health insurance requirement only works if Americans have affordable health care options and employers do their part. If health care is not affordable, or if employers are not sharing in the cost of health insurance for their employees, then we’re just increasing the profits of insurance companies and saddling the uninsured with increased health care costs.

As health care premiums skyrocketed nationally by nearly 120% from 1999 to 2008, more and more Americans have joined the ranks of the uninsured and underinsured. Government needs to spark increased competition and expand affordable choices for Americans in whatever form that may take. We did it in Massachusetts by demanding more competitive insurance plans through CommCare and Medicaid expansions.

The mandate is simply the mechanism that levels the playing field and puts an end to seemingly endless cost-shifting. After all, we all pay for the cost of caring for the uninsured; it’s reflected in our health care premiums as well as our taxes. Now that subsidized plans are available to 150,000 Massachusetts citizens, we have not seen runaway cost increases. For the first three years of reform, we have been able to keep the cost increases well below the national average, at only 5% a year. At the same time, national private insurance rates have been increasing by 120% over the last ten years.

Setting a goal of expanding insurance to everyone does more than any outreach plan or public service announcement ever could to expand care to those who need it most through Medicaid and SCHIP and maximize federal healthcare dollars. In addition, we have found that it has brought in more young adults (the largest group of the uninsured) which in the long run will help slow the cost of insurance by balancing the risk pool.

Today, roughly 25% of patients consume 75% of health care dollars spent in this country. A health insurance mandate opens the door to near universal access to preventive care and better management of costly and life-threatening chronic diseases such as asthma, obesity, and diabetes.

As we know very well from our shared experience on the Connector Board, passing the legislation is just the starting point. What matters just as much are the vision and the intent behind the reforms and how that vision can change and adjust to meet the healthcare needs of Americans. As we’ve learned in the Commonwealth, a vision of “shared responsibility” must be the underlying principle for the national healthcare reform bill now being hammered out between the House and Senate.

This program aired on January 13, 2010. The audio for this program is not available.

Headshot of Rachel Zimmerman

Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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