With the nation’s health care cost crisis set to assume a prominent place in the 2008 Presidential debate, Massachusetts’ Republican governor and its Democrat legislature took dramatic action this spring in what both sides say could be a groundbreaking solution to the crisis: a mandatory, universal health insurance requirement for all commonwealth residents.

Just as car owners are required to carry automobile insurance, everyone who lives in Massachusetts will be required to have health insurance, effective July 1, 2007.

“The health care cost crisis weighs heavily on LIUNA’s health and welfare funds and on the nation as a whole,” says LIUNA General Secretary-Treasurer, New England Regional Manager and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “With costs rising so sharply, more and more Americans are going without coverage, and our funds end up subsidizing their care through inflated hospital rates. While we’re doing everything possible to address this crisis, we can’t do it alone. So, we are looking very carefully at this new initiative in Massachusetts.”

“The big question is how the funding is going to work,” says State Representative Martin J. Walsh (D – Dorchester) who also is President of LIUNA Local Union 223 in Boston. The funding regulations will be worked out by the state’s Division of Health Care Finance and Policy and introduced in the legislature for approval later this year.

“Though this is not the ‘end all-be all,’ it is a good first step,” says Walsh, who once worked for the Massachusetts Laborers’ Health and Welfare Fund. He believes that, ultimately, “90 to 95 percent of the people will be covered, and this will reduce the amount of free care provided through the state’s uncompensated care pool, keeping more money in union trust funds.”

Though the general concept is well-outlined, many of the program’s practical details remain to be resolved. For instance, residents who do not get insurance through their employer will have to purchase their own insurance unless the state certifies that no affordable policies are available; however, a new state agency still must make adjustments in state regulations to entice insurers to provide low-cost policies. Also, residents with incomes below 300 percent of the federal poverty level will pay on a yet-to-be-determined sliding scale. In addition, several details regarding employer contributions to the program remain to be clarified.

Analysts point out that Massachusetts is in a unique situation because it has an established fund to cover care for its 500,000 uninsured residents and this allows the state to subsidize the launch of the mandatory insurance program. However, that funding is not permanent, so long-term adjustments may be necessary. Other states may not have the funds necessary to initially subsidize a mandatory program. In those cases, required coverage would simply impose more costs on people who cannot afford care in the first place.

“This will spark a discussion,” says Walsh, “and that is a good thing. My own opinion is that you can’t have universal health care in just one state. We could end up attracting people from other states. It’s really a federal problem.”