The Health Care Amendment
FOR A CONSTITUTIONAL AMENDMENT RELATIVE
THE PROVISION OF HEALTH INSURANCE
(Official Language with Footnotes)
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:
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)
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(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
- Does not create an individual right to specific health services, treatments
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
- 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.
- 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
- Does not include or preclude access to new and unproven technologies.
- 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
- 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
- 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
- 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
- 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.
- 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
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.
Petition with Signers
Constitution of the Commonwealth of Massachusetts