Some in Mass. Worry Over How to Pay for Compulsory Health Coverage

Linda Thompson barely gets by on her $200-a-week job. The 47-year-old elder care worker is able to cover the rent and fuel costs for her Pelham apartment, gas up the van that gets her to clients in Boston and buy some groceries.

By the end of the month, there’s nothing left for nice things like new clothes or dinner with friends. Or health insurance.

So with the prospect of being forced to pay for a policy under the state’s sweeping health care reform bill or face a fine, Thompson is worried that her tightly stretched budget is going to snap.

“Even if it’s going to cost just $100 a month, there’s no way I could pay it,” said Thompson, who moved to western Massachusetts from Boston about two years ago expecting a less expensive lifestyle but also a job that would pay more than $10,400 a year.

Under the bill, which is expected to be signed by Gov. Mitt Romney this coming week and go into effect next year, anyone who can buy insurance but doesn’t will face financial penalties. By 2008, people who aren’t enrolled in a health care plan could face fines topping $1,000.

The state’s poorest residents making less than $9,800 will not have to pay any premiums for their mandatory policies. But those earning between $9,800 and $29,400 a year will be required to pay a premium based on a still undetermined sliding scale.

And that worries some low-income residents and health care advocates for the poor.

“It’s going to be interesting to see if you can really force poor people with no insurance to pay a premium for a mandatory policy,” said Sarah Kemble, executive director of the Community Health Center of Franklin County in Turners Falls, which provides care to about 4,000 patients with and without insurance. “It’s possible that this whole thing is a false promise.”

Proponents of the measure say the mandate is a key pillar of the health plan.

“If people don’t take personal responsibility for their own health insurance, then the rest of us have to pay when that person ends up in the hospital,” Romney spokesman Eric Fehrnstrom said this week. “There’s nothing fair about that.”

For many of those making less than $9,800, the new legislation is nothing less than a lifesaver.

“When you have to go days without eating because you need your pain medication, you get really excited when someone says they’re going to help you all of a sudden,” said Jill Estell, who is 45 and has recently been staying at a homeless shelter in Northampton.

She suffers from chronic back pain brought on by a degenerative disc condition she thinks is tied to a motorcycle accident she had 20 years ago.

The last time she had steady insurance was the last time she had a job. But she lost her part-time position at a convenience store more than three years ago because standing all day as a cashier and having to stock shelves hurt her back too much.

So to pay for her medication since then, she says she’s had to sell her car, pawn her jewelry or go without food.

Brenda Berge Galloway, a case manager for Health Care for the Homeless, said the new legislation will pretty much guarantee that Estell and people in similar situations will have the access to the health care they need.

“It’s what we’ve been waiting for,” Galloway said about the reforms. “For our clientele, this is the answer to their problems.”

But for people like Thompson, the law could be nothing but trouble.

For now, Thompson is in good health. Her blood pressure is a bit high, but she’s able to get the care she needs through a network of free clinics she’s located throughout western Massachusetts. Because she isn’t disabled or pregnant, she doesn’t qualify for MassHealth, the state’s current Medicaid program.

On one hand, she feels good that health care coverage will be more accessible to more people, including herself. “I’m getting older, and that’s when you need more care,” she said.

But she has no immediate promise of getting richer. So being told she has to buy insurance she can’t afford doesn’t make much sense to Thompson, who just might find that it’s cheaper to pay a fine than buy a policy.