NCPA - National Center for Policy Analysis


February 26, 2009

Modeling the U.S. health care system after Massachusetts' health insurance law -- which requires nearly everyone to carry insurance or face fines -- would leave many residents without affordable health coverage, according to analysis by three Harvard Medical School physicians.

According to Dr. Rachel Nardin, a neurologist and an assistant professor, and Drs. Steffie Woolhandler and David Himmelstein, both primary care physicians and associate professors:

  • The state data is questionable -- it shows all but 2.6 percent of Massachusetts' residents are insured, however, the number is probably 5 percent or more.
  • They claim that insurance coverage under the new law has created unaffordable out-of-pocket costs for lower- and middle-class residents, particularly those with chronic illnesses.
  • The new law also is more costly than expected, which has resulted in reductions to state funding of "safety net" providers that offer no-cost care to low-income residents, the physicians said.

Besides these structural problems, Massachusetts' plan is about to be put to the test by the bad economy, says the Associated Press:

  • Unemployment in the state has climbed over the past three years from around 4.8 percent to close to 7 percent, meaning 72,000 more people are out of work now than when the law was signed in 2006; many of the newly jobless may have to buy their own insurance.
  • People who fail to obtain insurance can be hit with fines that could top $1,000 for an individual during the 2009 tax year.
  • The fine is deducted from the individual's tax refund. If the refund isn't enough to cover the fine, the state bills the taxpayer for the balance.
  • About 60,000 people had to pay a penalty for not having insurance in tax year 2007, according to the state Revenue Department.
  • The penalty for that year was $219 for an individual, $338 for the head of a household, but the penalty was waived for tens of thousands of other taxpayers.

With the Obama administration hoping to expand health care nationally, the fate of Massachusetts' program is being watched closely.

Source: "Massachusetts' 2006 Health Insurance Law Not A Good Model for National Health Care System Reform, Physicians Say,", February 23, 2009; based upon: Dr. Rachel Nardin, Dr. David Himmelstein and Dr. Steffie Woolhandler, "Massachusetts' Plan: A Failed Model for Health Care Reform," Harvard Medical School, February 18, 2009; and Steve LeBlanc, "Mass. health system is being tested by recession," Associated Press/, February 23, 2009.

For Harvard Medical School study: 

For Fox News text:,4670,MassachusettsInsurance,00.html 


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