The Health Care Amendment

PETITION FOR A CONSTITUTIONAL AMENDMENT RELATIVE

TO THE PROVISION OF HEALTH INSURANCE
(Official Language with Footnotes)

SECTION 1: The People of the Commonwealth of Massachusetts hereby declare it necessary and expedient to alter the Constitution by the adoption of the following Article of Amendment:

Upon ratification of this amendment and thereafter, it shall be the obligation and duty(1) of the Legislature and executive officials, on behalf of the Commonwealth, to enact and implement such laws, subject to approval by the voters at a statewide election(2), as will ensure that no Massachusetts resident lacks(3) comprehensive(4), affordable(5) and equitably financed(6) health insurance(7) coverage for all medically necessary(8) preventive, acute and chronic health care and mental health care services, prescription drugs and devices goji cream asli (9).

INTERPRETATION OF LANGUAGE**

1. "obligation and duty"

• This mirrors the Supreme Judicial Court’s interpretation of the Article of the Massachusetts State Constitution that it held created an enforceable right to a public K-12 education for every child in the Commonwealth in McDuffy v. Secretary of Education (382 Mass. 545 (1993))
• Creates an enforceable right for the Commonwealth's residents in the aggregate.
• Does not create an individual right to specific health services, treatments or coverage.

2. "voter approval"

• Added by the 2004 Constitutional Convention to ensure voters would have the opportunity to approve any specific plan developed to meet the requirements of this constitutional mandate before the plan is implemented.

3. "no Massachusetts resident lacks"

• Goes to the issue of universality of coverage, which is a prerequisite to improving quality of care, improving the health status of all Massachusetts residents, reducing disparities in health status among Massachusetts residents, containing costs, preventing cost shifting and simplifying administration of our health care system.
• Requires the Commonwealth to ensure there is at least one place where every resident can obtain coverage whether in the private market or through a public program or programs.
• Does not require the Commonwealth to be or preclude it from being an insurer but probably does require the Commonwealth to at least "make a market" in insurance as it does for public employees through the Group Insurance Commission.
• Leaves elected officials free to define residency based on any of a variety of variables including duration of physical presence and intent for moving to Massachusetts.

4. "comprehensive"

• Implies a significantly broad benefit package to ensure the best value for resources allocated.
• Should be read with "preventive, acute and chronic health and mental health care, including prescription drugs and devices" to include a full range of cost-effective, coordinated, evidence-based medical, surgical and mental health care services to prevent and treat illness and injury.
• Requires coverage for effective screening and disease prevention services.
• Should be read with "affordable" and "medically necessary" to establish limits which could change over time to reflect changes in evidence-based best practices, available resources and innovative technologies.
• Does not include or preclude access to new and unproven technologies.

5. "affordable"

• Applies equally to all stakeholders - individuals, employers, insurers, providers and hospitals, to name a few - that currently finance or subsidize the health care system whether as consumers of insurance or services, taxpayers or providers of uncompensated or under-compensated care.
• Requires pricing that does not create an unreasonable financial barrier to obtaining the coverage essential for access to timely, cost-effective care.
• Implies some form of subsidy for low- and middle-income residents and their families, the self-employed and their families, and for businesses with limited or negative cash flow - just as employers that offer insurance and their workers currently receive public subsidies through the tax system.
• Requires cost containment, including, perhaps, some form of overall cap to real spending.
• Encourages, if not requires, cost savings through:
  • Administrative simplification, streamlining and modernization;
  • Incentives to providing timely, cost-effective, evidence-based care in appropriate settings;
  • Improved quality and safety to reduce medical errors and avoidable hospitalizations;
  • Consumer education about how to lower costs by seeking appropriate care early, making life-style changes, following treatment programs;
  • Consumer education about the relative benefits and cost-effectiveness of different interventions, etc;
  • Reimbursement system reforms to encourage prevention, coordinated care, follow-up to reduce the need for expensive, high tech interventions;
  • Bulk purchasing where applicable;
  • Elimination of redundant health insurance components of workers compensation, auto and other liability insurance products.

6. "equitably financed"

• Assumes that every stakeholder who benefits, either directly or indirectly, from a universal health insurance system contributes to financing it whether through direct payments, taxes or tax expenditures.
• Implies some sort of sliding-scale premium mechanism based on ability to pay.
• Assumes an end to cost shifting among stakeholders.
• Implies creation of a reserve fund to ensure adequate resources to provide coverage during periods of unusually high demand for services or subsidies and/or revenue shortfalls.

7. "insurance"

• Insurance, whether public or private, is the standard mechanism used to spread risk and control the costs of unpredictable and/or episodic events. The word itself does not suggest a private or public system as our current patchwork of private and public health insurance programs demonstrates.

8. "medically necessary"

• Well-litigated term used by all public and private insurers to define coverage, utilization and costs that will minimize the likelihood of further litigation on coverage issues.
• Implies the inclusion of benefits based on medical evidence and/or consensus medical opinion.

9. "health care services"

• The MassHealth Standard benefit package would represent a reasonable interpretation of this language.
• It implies that "gap" insurance would be available to the underinsured, including a medigap plan for Medicare beneficiaries.

** These interpretations are provided simply as illustrations of what might be considered reasonable and to which the courts might be expected to defer.

Original Petition with Signers

The Constitution of the Commonwealth of Massachusetts