Chapter 58’s most controversial provision is an individual mandate which requires all uninsured residents to purchase health insurance if an “affordable” plan is available. Those below 150% of poverty get free coverage, those from 150-300% get sliding subsidies, while everyone else (about half of the uninsured) must purchase coverage on their own. The standards for affordability have been criticized by health care advocates.

Governor Mitt Romney publicly supported the individual mandate as a means of eliminating so-called “free riding” in the health care system. Romney claimed that “40% of the uninsured were earning enough to buy insurance but had chosen not to do so” (Wall Street Journal). Patients at 300% of the poverty line and up - those targeted as “free riders” by individual mandate supporters - represent less than 5% of uncompensated care costs in Massachusetts, however.

The Personal Responsibility Movement grew largely out of Newt Gingrich’s attack on welfare receipts, the “Personal Responsibility Act” of his 1994 “Contract with America.” The Personal Responsibility Movement aims to prevent “free riding” by public program recipients, and shift financial burdens onto disadvantaged communities, often through punitive enforcement mechanisms. This idea was revived in the 21st Century in the effort to solve the health care crisis.

An individual mandate is one of the most regressive ways of paying for expanded health coverage, shifting responsibility for health care costs onto individual households. Additionally the penalties for non-compliance are extremely stiff. In its second year residents will be fined roughly $1,000 for being uninsured, similar to the fines for some serious crimes.

Further Resources:

• “New York Times examines Massachusetts Individual Health Mandate,” Kaiser Daily Health Policy Report, November, 2007.