Health insurance companies and HMOs in Massachusetts are battling grass-roots organizations in an increasingly desperate campaign over a state referendum that would require universal health coverage.
Opponents of Question 5, which continued to have strong popular support in the most recent public poll, will spend $4 million trying to defeat it. The issue will be decided by Massachusetts voters Nov. 7.
Those opposed call the proposal politically inviable, arguing that such a requirement would doom existing HMOs and undermine Chapter 141, the state's tough new managed-care reform law, which is set to take effect in January.
Question 5 proponents say the measure aims to correct an unconscionable problem, and that passage would carry great significance as a signpost pointing the country toward guaranteed health coverage for all.
Approval of Question 5 would prohibit the conversion of not-for-profit hospitals, HMOs and other health insurers to for-profit until a system ensuring comprehensive healthcare coverage for all state residents is in place. The measure says the universal coverage system must be operational by July 2002.
While the initiative would require the state to ensure comprehensive, high-quality care and health coverage for all its residents, it does not specifically define a means to pay for such a system.
The measure does mandate that only 10% of premium revenue could be spent on administrative expenses.
The fight has been intensifying as Nov. 7 approaches.
According to state campaign finance records, Blue Cross and Blue Shield of Massachusetts has contributed more than $1.2 million to the "No on 5" campaign. Harvard Pilgrim Health Plan has chipped in $500,000, and Tufts Health Plan has given $430,000.
Campaign spokesman Stephen Allen said provisions of the ballot measure, including guaranteeing patients the right to freely choose their health providers, would effectively gut HMOs.
"These organizations, as we know them today, would fundamentally cease to exist," Allen said.
"The broad-based, very strong support is commensurate with the broad failures of the current healthcare system," said Ann Eldridge, a registered nurse serving as the "Yes on 5" campaign spokesperson.
Although proponents of Question 5 say they are spending only about $50,000 on the campaign, the initiative continues to hold popular support. The most recent poll, sponsored by local news organizations and taken Oct. 24-26, show 50% of 400 likely voters supported Question 5, 25% opposed it and 25% are either undecided or unwilling to answer.
National organizations are beginning to take note. A spokesman for the American Association of Health Plans initially said the AAHP is staying out of the fight and wouldn't speculate on its national significance. In a later interview, however, Karen Ignagni, the AAHP's president, called Question 5 a "u-turn back to fee-for-service." She said it would result in higher healthcare insurance premiums and reduced access to care.
Sen. Edward Kennedy (D-Mass.), who is up for re-election in Massachusetts on Nov. 7, is voting for Question 5, but his staff would not predict whether the state measure would have any national impact.
One group that has closely tracked the universal healthcare issue sees Massachusetts as a bellwether.
"The fact that this issue is getting such high profile there is significant regardless of the outcome," said Diane Lardie, national director of UHCAN! (Universal Health Care Action Network), a Cleveland-based grass- roots advocacy organization. "We hope that this will lead the way for the rest of the country."
Despite the measure's public support, the healthcare establishment and some labor groups in Massachusetts are all over the board on Question 5.
The Massachusetts Nurses Association, the League of Women Voters of Massachusetts and the Service Employees International Union have endorsed the measure.
The Massachusetts Hospital Association hasn't taken a position.
Lining up against it are the Massachusetts Medical Society, state Commissioner of Public Health Howard Koh, M.D., and several members of the Coalition for Health Care, which got the initiative on the ballot.
The Massachusetts Legislature passed Chapter 141 in July. Some observers believe the measure is one of the strongest managed-care reform efforts in the country. The law will establish a process enabling patients to appeal treatment denials through a state Department of Public Health office.
Health Care for All, a member of the Coalition for Health Care steering team, abandoned support for Question 5 once the Massachusetts managed-care reform law passed.
"One of our concerns is that this (Question 5) would really jeopardize what has passed," said Marcia Hams, deputy director of Health Care for All.
Opponents of Question 5 have criticized the measure for being poorly written and vague, not to mention politically inviable.
"It promises an awful lot without giving us any of the details," said Paul Jacobson, Massachusetts' deputy public health commissioner.
Exactly what will happen if Question 5 passes is unknown. The Massachusetts Taxpayers Foundation released a study saying the measure would cost residents an average of $800 more per year, the equivalent of an income tax increase of 15% to 25% for state residents. Proponents of Question 5 said their plan would be budget-neutral because the reduction of healthcare administrative costs would more than pay for the cost of covering the entire population.