Demographics Affect Health Care Reform Efforts

Economic and demographic differences between states could make implementing a health insurance mandate similar to the law recently passed in Massachusetts difficult in California, the Los Angeles Times reports (Keller/Lin, Los Angeles Times, 5/8).

The Massachusetts legislation would require all residents to purchase health insurance by July 1, 2007, and would create a low-cost, state-subsidized health insurance program for residents with incomes up to 300% of the federal poverty level (California Healthline, 4/27).

Among the differences between California and Massachusetts:

• There are about 6.5 million uninsured Californians, compared with 600,000 uninsured residents in Massachusetts;
  
  
• California businesses are less likely to offer health benefits to workers; and
  
  
• Massachusetts will use an established $1 billion fund already dedicated to health care to finance the mandate, while California has no comparable fund.

Health experts say major changes would be needed to make the Massachusetts model viable in California. For example, the state could require employers who do not offer health coverage to pay more into the system.

The state also could require residents to purchase only catastrophic coverage, rather than the comprehensive coverage required in Massachusetts, to lower costs. However, a bill proposing a similar plan, by Assembly member Keith Stuart Richman (R-Granada Hills), was defeated in committee last month.

In addition, the Assembly Health Committee last month approved a bill that would require employers who do not offer insurance to pay 75% of a worker's health costs to the state, but no Republicans voted for the bill. Support from some Republican lawmakers would be needed for the bill to pass the Assembly (Los Angeles Times, 5/8).