Legislature Advances Universal Health Constitutional Amendment

By Cyndi Roy, STATE HOUSE NEWS SERVICE

STATE HOUSE, BOSTON, JULY 14, 2004 -- The Legislature today approved a citizen's initiative that would constitutionally require lawmakers to create a plan to provide "comprehensive, affordable, and equitably financed health insurance coverage" to all Massachusetts residents.

Meeting in Constitutional Convention, House and Senate members okayed the bill (H 4444) on a vote of 153-41. To reach the ballot in 2006, the initiative must be approved again in the next legislative session, which begins in January 2005.

Democratic legislative leaders split their votes, with Senate President Robert Travaglini voting for the bill and House Speaker Thomas Finneran voting against it. Lawmakers from both parties were divided on the issue.

The bill reads, "It shall be the obligation and duty of the Legislature and executive officials, on behalf of the Commonwealth, to enact and implement such laws as will ensure that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage for all medically necessary preventive, acute and chronic health care and mental health care services, prescription drugs and devices."

Leaders of the Health Care for Massachusetts Campaign, a coalition of business leaders, small business owners and health care providers, entered today's convention claiming they had commitments from 51 lawmakers to advance their proposal. But they attracted far more after lawmakers adopted an amendment requiring the universal health care plan devised by lawmakers to be submitted to voters for final approval. Amending a citizen's petition for a constitutional amendment requires a three-fourths majority of the Legislature. The amendment adopted during today's convention was adopted without a roll call and on a voice vote, and Travaglini, who was presiding, suggested that the voting hurdle had been cleared.

There was some confusion as the vote was called. After Sen. Steven Tolman (D-Brighton) moved the question, a motion intended to expedite a final vote, Travaglini moved directly to a roll call on the constitutional amendment, skipping a vote on Tolman's motion. Legislative leaders verbally explained that the vote was on the amended constitutional amendment, but the electronic roll call board, as well as printed roll call documents from the House clerk's office, said the vote was on moving the question.

The amendment's sponsor, Sen. Richard T. Moore (D-Uxbridge), co-chair of the Joint Committee on Health Care, said he supported the constitutional amendment, but felt it was necessary to make the Legislature explain to voters how the mandate would be funded, and allow them to decide its fate.

"There's no such thing as a free lunch, and there's no such thing as free health care, either," he said. "It's all fine and good to be for health care, but we also have to understand that all of us have to pay something for it."

The earliest voters could vote on the universal health care plan would be 2008. If it is accepted, Massachusetts would become the first state in the country to provide universal health care to its residents. Proponents of the universal health care initiative celebrated the vote, though some remained skeptical of Moore's amendment, saying opponents could use the language to thwart attempts to provide coverage for the estimated 600,000 uninsured citizens.

"I am pleased that the original question is advancing, but I'm disappointed that the amendment went through on a voice vote because this issue is important enough that legislators should want to stand up and be counted," said Sen. Mark Montigny (D-New Bedford), former co-chair of the Health Care Committee. "I think we need to be careful, skeptical and watchful because the opponents of universal health care are formidable; they are driven by money and special interests, not public interest."

The Committee for Health Care for Massachusetts, the initiative's sponsor, expressed cautious optimism on the vote.

"We are very grateful that the amendment came to a vote because we have a responsibility to the voters," said Barbara Roop, co-chair of the committee. "Our concerns is that the amendment could be abused by opponents as a way of freezing all health care reforms until 2008."

Opponents of the constitutional amendment argue the state does not have the money to provide universal coverage. Some opponents have also argued Massachusetts will become a magnet for the uninsured.

"At the end of the day, the taxpayer is going to foot the bill," said Rep. Peter Larkin (D-Pittsfield), who voted against the bill. "The people who voted for this are the same ones who voted to roll back the income tax. There is no way we can afford it. Those who argue health care is a right-well, rights stem from responsibility."

Larkin also argued that the state is already providing health care for all citizens through its uncompensated care pool, which is funded by hospitals, insurance companies and taxpayers. Sen. Steven Tolman (D-Brighton), a leading supporter of the initiative, disagreed, saying that between 33 and 39 cents of every dollar spent on health care is not spent on direct services, and could be used to help fund expanded coverage.

"It is the fundamental right of all citizens of Massachusetts to be entitled to affordable health care," he said. "It should not be predicated on economic status. Health care should be a right, not a privilege."

While the focus of the debate on universal health care has been trained on the constitutional amendment, the Senate has already approved a bill requiring regulators to detail the fiscal impact of universal health care. A House Ways and Means plan that emerged last week expanded on the Senate proposal, calling for a study of the impact on taxpayers and the state budget, health care industry wages, the current employer-based insurance system and the potential rationing of health services and prescription drugs.

After today's convention, the House gave initial approval to legislation offered by Rep. Peter Koutoujian (D-Newton), co-chair of the Health Care Committee, directing the Division of Health Care Finance and Policy to study the fiscal impact of establishing a Health Care Trust. The trust would be the sole source of financing health care for the uninsured. The study would examine the total cost of implementing universal health care; the amount of new state revenue necessary; the potential cost savings; the effect of such a plan existing jobs, companies, health care institutions and health care providers; the impact on state and federal laws, Medicaid, Medicare and the uncompensated care pool; the effect on residents with and without coverage; the effect on the employer-based system; administrative costs, and the potential migration of residents in and out of state.

A final report would have to be filed by April 1, 2005.

"Each side has reports that are very extremely different, and no matter
which side you support, it's a leap of faith," Koutoujian said. "We need
real answers to what a single payer system would cost, and if the study is
done properly, it's going to shed a lot of light on whether we can get
universal health care."

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