SIXTEEN YEARS ago, with bands playing and balloons flying, I signed the second universal healthcare bill in America on the steps of the State House. Only the state of Hawaii had beaten us to it.
That bill would have provided comprehensive health insurance for every resident of the Commonwealth. It would have controlled hospital costs. It required all employers with six or more employees to provide their employees and their families with health insurance with a contribution from the employees of up to 20 percent of the total premium. It guaranteed students health insurance while attending college in Massachusetts. It made sure that people who had been laid off from their jobs received health insurance for themselves and their families. And it made special provision for those with the kinds of disabilities that made them virtually uninsurable.
It was approved by the Legislature with one of the broadest political coalitions that had ever been put together on Beacon Hill. The Massachusetts Medical Society supported the bill. So did the hospitals. So did the state nurses' association. So did Health Care for All, the state's principal advocacy group for universal healthcare. So did the unions. And so did most of the state's business community.
That support from the business community had a lot to do with the leadership of a remarkable man named Nelson Gifford. Gifford was the president of Dennison Manufacturing Co. and a member of the state's Business Roundtable. He understood what the healthcare system was doing to the approximately 70 percent of the state's employers who were insuring their employees and their families. Not only were they paying high and growing premiums for their health insurance; those premiums included a hefty surcharge to pay for the cost of free care in emergency rooms and community clinics for people whose employers did not insure them.
Gifford thought that was grossly unfair, and so did I. Working together with other members of our coalition and with key state legislators, we won passage of the bill and sent out a message that working people and their families and the employers for whom they worked would be provided with comprehensive healthcare in a fair and balanced way.
Under the bill certain kinds of coverage were to be provided immediately, including the student guarantee and health benefits for the unemployed. Thanks to those two steps alone, 100,000 Massachusetts residents have health insurance that would not have been there for them prior to l988.
Unfortunately, we provided a three-year phase-in process for the employer mandate, and after I left the governor's office, my successor, Bill Weld, did everything he could to kill or delay its implementation because he claimed it would hurt business. Weld never seemed to understand what we were doing to the majority of our employers who were doing the right and responsible thing and insuring their employees.
Then, to add insult to injury, he signed a premium tax bill that now forces them to pay a tax over and above the cost of their premiums to pay for free care for uninsured workers.
Between the Weld tax and increased hospital rates required to pay for free care, Massachusetts employers who insure their employees are now paying nearly $350 million a year in taxes and surcharges on their premiums to provide healthcare for people who are not their employees and who in some cases are employed by businesses that are competing against them.
In short, we already have an employer mandate in this state. If you insure your employees, you also have to pay for the guy that doesn't.
While I commend Governor Romney for joining Senate President Travaglini in helping to put healthcare back at the top of the state's agenda, he doesn't seem to understand how the system works any better than Weld did. He, too, says he opposes an employer mandate and is now looking for other ways to force recalcitrant employers to insure.
So let's get real about our healthcare future. If we are serious about providing comprehensive healthcare for all of our residents in this state and saving responsible employers and the taxpayer the billions of dollars we are spending on uninsured employees and their families, there will have to be a state-imposed mandate that requires most employers and their employees to contribute to the cost of health insurance.
Yes, there is a case to be made for exempting small businesses and start up companies just as we did in 1988, and we should think seriously about what that exemption should be. In 1988 we limited it to businesses with no more than a handful of employees. We might want to increase that exemption to, say, businesses with no more than 15 or 20 full-time employees. Even at that level, however, we could cover nearly half of the people who are currently uninsured in this state without any impact on the state budget and, at the same time, reduce premiums for the businesses that are already insuring their employees and their families.
But trying to patch up the present system with Band-Aids and paper clips while ignoring the growing burden it is placing on businesses, including a lot of small businesses, that continue to insure their employees is not pro-business. It is antigrowth and antibusiness, something that the governor and the business community should clearly recognize.
In fact, I have a suggestion for both the administration and the Legislature that will save them a lot of time and trouble. Dust off our 1988 bill. Decide at what level you want to place the exemption for small businesses. Save yourself a bundle of Medicaid money that will no longer be required to insure the children of working people whose employers do not insure them, and use that money to cover the remaining uninsured.
Better still, call Nelson Gifford out of retirement and let him educate you, as he did me, on just how antibusiness the current system is.
And if memory serves me right, he was a Republican.
Michael S. Dukakis is a former governor of Massachusetts.