Mass-Care and PNHP press release on the individual mandate and the Supreme Court ruling.
June 22, 2012
Groups Release Data Showing Massachusetts Individual Mandate Hit Middle-Class Income Hardest, Public Insurance a More Equitable Alternative
BOSTON - June 21 - The Supreme Court’s decision on the Affordable Care Act, expected before the end of the month, hinges on the constitutionality of its most controversial provision: the individual mandate. Data released by Mass-Care and Massachusetts Physicians for a National Health Program shows that the mandate, which has been in effect for five years in Massachusetts, was highly inequitable in the immediate aftermath of reform – hitting primarily lower middle-class families’ budgets. In contrast, publicly funded health plans such as most countries use to provide universal health care, or as represented by the new subsidized care for low-income residents, is a constitutional and more equitable means of expanding coverage to the uninsured.
“While this model of health reform is often described as a ‘shared responsibility,' payment of reform in Massachusetts has been anything but a shared responsibility,” commented Benjamin Day, Executive Director of Mass-Care and co-author of the report. “While the lowest income residents in the state were protected by health reform, the middle class – particularly those just above income levels where they qualify for public subsidies – saw a jump in their health care costs that these families just can’t afford.”
The report found that health spending as a share of income fell for the lowest 20 percent of income earners between 2005 and 2007, a before-and-after snapshot of the 2006 health reform law in Massachusetts. However, for families just above this threshold, earning between $20,000 and $41,000 a year, the increase in their health spending amounted to 4.6% of their income. In contrast, the top earners in the state saw health spending increases that amounted to only 0.4% of their income.
Russ Davis, Executive Director of Massachusetts Jobs with Justice, noted that “Unfortunately the experience in Massachusetts has shown that the individual mandate does nothing to relieve the steady increase in health care costs, putting an untenable burden on families and state and municipal government. In addition, taxing decent health care plans, mis-labeled ‘cadillac health care,’ forces employers and employees into constant confrontation. We should be instead looking at a single payer system that can reduce costs and increase coverage.”
Activists have accelerated efforts to pass “single payer” health reform at the state level, which would provide health care as a universal public service, like most industrialized countries currently do. Vermont in early 2011 passed legislation that will move that state to a single payer system over the next six years. The Massachusetts Senate last month debated a similar proposal, which was voted down by a narrow four-vote margin, a margin advocates feel they can overcome in the near future.
Dr. Jim Recht, Chair of Massachusetts Physicians for a National Health Program and a psychiatrist at Cambridge Health Alliance, noted that “it's wrong to pay for health reform on the backs of lower-income families already in debt from rising energy, transportation, food, and housing costs. A single payer health plan is the just alternative: it has been proven to control costs; it is constitutional; and it would be paid for equitably, by low- and high-income earners alike.”

(Source: Estimates from “Massachusetts Health Reform in Practice: and the Future of National Health Reform,” Benjamin Day and Dr. Rachel Nardin et al, Mass-Care and Massachusetts Physicians for a National Health Program, October 2011.
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