CITIZENS   FOR  LIMITED  TAXATION
and the
Citizens Economic Research Foundation

CLT UPDATE
Tuesday, April 4, 2006

"Jason and Tiffany" will survive!


Spring brought blooms of yard signs to the broad lawns of Wrentham, where a vote Monday on raising property taxes is dividing the town. On one block were signs of revolt -- "No $1,100,000 tax override" -- while signs in nearby yards scattered with small bikes and toys urged their neighbors to vote yes.

"People that got kids in the school want the override and those that don't, don't," said Richard Campbell, 56, who lives along a row of modest homes tucked into the woods off Wrentham's Creek Street. "We get all these people making all this kind of money and they want everything they want, and they want everybody to pay for it." ...

"The need for overrides is greater than ever in order just to protect the existing level of services," said Michael J. Widmer, president of the Massachusetts Taxpayers Foundation....

But other town residents think they are being dealt a false choice and blame local officials for poor financial planning.

Chip Faulkner -- associate director of the statewide antitax group, Citizens for Limited Taxation, and a Wrentham resident -- said he believes the argument voiced by Romney's former budget chief, Eric Kriss, that municipalities have still not learned to live within their means.

"Because they can't control the runaway spending, they're asking us for a tax hike," Faulkner said. "That's ridiculous. Keep your budget under control."

The Boston Globe
Saturday, April 1, 2006
Short of cash, towns turn to overrides
Reduced state aid means struggle to pay bills for some


The Massachusetts Taxpayers Foundation is already warning that the proposed increase in local aid eliminates "essentially all of the fiscal flexibility created by the recent strong growth in tax revenues," and says this level of assistance will be difficult to sustain in the future, especially if the Legislature approves a costly health-care program....

Speaking of the health-care bill, here's the Citizens for Limited Taxation take on the proposed House-Senate compromise:

"Adding a new $295 tax for companies that do not provide health insurance is adding another bad tax to an existing bad tax. Massachusetts should repeal the $62 (currently assessed against those who do provide insurance), and not assess the $295. ... If the final bill looks like the bill that is presently being floated, Governor Romney should veto it, then address it as president of the United States."

The Salem News
Friday, March 31, 2006
Weekly political column
By Nelson Benton


Hilary Clinton and Ira Magaziner were widely criticized in 1993 and 1994 for attempting to remake the vast, anarchic financing of the American health care system in secret, behind closed White House doors. With high-minded intentions the then First Lady showed she didn't then understand the basic workings of the democratic process.

In Massachusetts in 2006, Salvatore DiMasi and Robert Travaglini -- respectively, the House Speaker and the Senate President -- are putting Mrs. Clinton's penchant for secrecy to shame....

I don't like to speculate and I don't like to be cynical about the work of fellow human beings. But the disgraceful lack of forthrightness by the leaders of the two Houses and whomever they may be confiding in leaves me to fear the very worst.

Health Care Bill:
Fearing The Worst [Politicus #890]

Thursday, March 30, 2006
By David Mittell


Conference committee negotiators say the plan requires $125 million in new state money for each of the first three years of implementation, along with $184 million in federal contributions. After three years, lawmakers say the plan will be "revenue neutral," meaning additional state money would not be required....

A big question mark hanging over the bill is whether Romney will sign off on a new assessment on employers who don't offer insurance. Under the legislation, companies with more than 10 employees that do not offer insurance will be required to pay $295 per-employee into a state-controlled fund. All employers will be required to pay $62 a-head, a fee they are currently charged.

Additionally, if employees at non-offering companies do not purchase affordable insurance on their own and have their health care paid for under the Uncompensated Care Pool, their companies will be charged an additional assessment. That "free-rider" surcharge is applicable only if employees rack up a treatment bill of $50,000 collectively, and if an employee requires treatment at least three times.

When asked about the per-employee assessment, Romney said he does not consider it a tax. "It's not a tax hike. It is a fee. It's an assessment." ...

Under the bill, individuals will be required to purchase an affordable product by July 1, 2007. Beginning with income tax forms filed in 2008, residents will be asked to verify coverage and forfeit their personal exemption for that year if they have not purchased an affordable product. Some residents could be eligible for a one-year waiver of that penalty, lawmakers said.

After the first year, residents not purchasing affordable insurance will be charged one-half the cost of the most affordable product.

The Department of Revenue will be charged with writing regulations and overseeing many portions of the individual mandate's implementation.

State House News Service
Monday, April 3, 2006
House, senate accord requires
big health insurance access expansion


Chip Ford's CLT Commentary

Statewide universal healthcare, and an insurance mandate on all parties to pay for it, at last seems to have finally made it through the Legislature, so at long last other business before the body can proceed.  As one state rep. noted:  "We're just pleased that it's over with."  Whether or not it's the "best solution" has yet to be analyzed.  We'll have more to say about it tomorrow, after everyone's had time to look it over for the details.  The devil, after all, is always in the details.

In the meantime, CLT associate director Chip Faulkner has had another win -- two in fact! -- in his hometown of Wrentham, which went to the polls yesterday and strongly defeated overrides (see Boston Globe report).  The general override went down: Yes 748, No 2189 74% No.  The vote on the Community Preservation Act: Yes 1299, No 1641.  Overrides can be defeated, and from the Wrentham results, taxpayers have had enough.

Like what Howie Carr calls the "Trustafarians," like the one Barbara described in his column, some have just more money than they know what to do with -- especially if they can get you to pay for their brood of offspring. As Mary Ann Nardone, from her pillared stately brick McMansion in a new Wrentham development, clarified below.  If you want basic public services like police or fire protection, your roads plowed, trash picked up, then you'd better pony up to support her brood in the means to which they've been born accustomed, or in her mind give it up:

"Nardone was so motivated by her love for Wrentham teachers that she and a friend paid for 50 lawn signs urging their neighbors to vote yes on the tax hike. With fliers warning that "your child will be affected by the override," she and other parents say that a defeat would spell doom in the classroom: Bigger class sizes, teacher layoffs, and the loss of programs like Spanish education and computer technology.

"'I keep telling them, I agree with you; I don't want more taxes,' Nardone said. 'However, if you want police, if you want fire, if you want Wrentham on the map, you have to pay.'"

And pay, and pay, and pay -- for the best for her brood and the education-industrial establishment she adores.

Or simply move out and let more of her kind move in, until she can't afford living there any longer either.

But Mary Ann and her Trustafarian friends lost yesterday!  What will Jason and Tiffany do next?  The youngsters will survive, make do, somehow.  We did.

Chip Ford


The Boston Globe
Saturday, April 1, 2006

Short of cash, towns turn to overrides
Reduced state aid means struggle to pay bills for some
By Stephanie Ebbert, Globe Staff

WRENTHAM -- Spring brought blooms of yard signs to the broad lawns of Wrentham, where a vote Monday on raising property taxes is dividing the town. On one block were signs of revolt -- "No $1,100,000 tax override" -- while signs in nearby yards scattered with small bikes and toys urged their neighbors to vote yes.

"People that got kids in the school want the override and those that don't, don't," said Richard Campbell, 56, who lives along a row of modest homes tucked into the woods off Wrentham's Creek Street. "We get all these people making all this kind of money and they want everything they want, and they want everybody to pay for it."

With another season of tax overrides in cities and towns, anxieties over property taxes are front and center in this year's race for governor, as candidates tap into voters' worries about rising taxes and high expectations for schools, police and fire service, and public works projects.

Already, candidates for governor are debating the merits of cutting the state income tax rate or using replenished state revenues to return more aid to local government, so they can offer homeowners some property tax relief. The towns say that they are starved for cash because of aid cutbacks by Beacon Hill and that their only outlet is an override vote under Proposition 2. The law limits the annual increase in taxes and requires voters' approval for extra tax hikes.

An improving state budget picture may mean money for cities and towns in the future, but for now some cities and towns -- Wrentham, Millis, and Needham among them -- are asking voters to pass overrides this spring. Driven by reduced state aid and skyrocketing healthcare costs for municipal employees, the number of tax cap override efforts nearly tripled between 2000 and last year. There were 164 override attempts last year, almost half the state's cities and towns, but only 87 succeeded. The total this year has not yet been compiled by the state.

Many of the overrides have been proposed not for glitzy new construction projects, but simply to pay the bills. In Millis, where voters last year defeated a small, $142,000 override to restore jobs in the Police Department and in public works, officials are trying again, pitching a $1.1 million override to help fund the schools, public safety, the library, and health and human services.

"The need for overrides is greater than ever in order just to protect the existing level of services," said Michael J. Widmer, president of the Massachusetts Taxpayers Foundation.

Beacon Hill is taking notice. Governor Mitt Romney's proposed budget for the fiscal year that begins in July calls for an additional $197.9 million for communities by lifting the cap on the state lottery, a proposal echoed last week by House Speaker Salvatore F. DiMasi.

Aid to cities and towns from the state budget has gradually increased since the state budget crisis of 2003. Despite the increase, the governor's proposed budget for next year would add just $16,000 to the Wrentham town budget, because other state aid is being cut, said town administrator Steven C. Boudreau. "I don't think the town of Wrentham is going to shut down, but we're not going to be able to do the same things as this year, next year," Boudreau said.

In Wrentham, a town of about 11,000 people that is home to the sprawling Wrentham Village Premium Outlets, the debate in the shops and front yards is about the value of town services and the cost to home finances. On Monday's ballot, Wrentham officials will ask voters to boost real estate and personal property taxes by an additional $1.1 million to pay for routine municipal services.

The tax override would add about $264 to the average single family tax bill of $4,579, based on data from the state Department of Revenue's Division of Local Services. On the same ballot, voters will decide whether to add another 2 percent on their property bills to protect land under the Community Preservation Act.

Voters have very personal opinions about whether the tradeoff is worth it to them.

"I'm not as worried about my tax bill as I am about the class sizes going higher than they are," said Kelly Foxx, a mother of three who supports the override.

"I don't think anyone wants to pay more taxes," Jack Unger, 43, who has two children in the schools, said as his son ate ice cream at Tootsie's Ice Cream in the town center. However, he added, "If there's no other options and that's been looked at, you don't have much choice."

But other town residents think they are being dealt a false choice and blame local officials for poor financial planning.

Chip Faulkner -- associate director of the statewide antitax group, Citizens for Limited Taxation, and a Wrentham resident -- said he believes the argument voiced by Romney's former budget chief, Eric Kriss, that municipalities have still not learned to live within their means.

"Because they can't control the runaway spending, they're asking us for a tax hike," Faulkner said. "That's ridiculous. Keep your budget under control."

Angry Wrentham taxpayers point to a flurry of construction projects that the town launched in recent years: a major renovation of Town Hall, two new schools and a high school addition, and a new public safety building that one selectman described as lavish.

"We have got the best of everything, and we can't afford the best of everything," said John Zizza, one of two selectmen who voted against putting the tax override before voters and who urges greater fiscal restraint. "I have a saying I've been using for years here: The best services in the world are meaningless if you can't afford to live here anymore. But there are people who don't care."

Mary Ann Nardone sees things differently. A mother of twin second-grade boys, who lives in a stately home in newer development, she likens the need for new town buildings to shopping for her family. "When you have children, they all need shoes at the same time," she said. "We can't wait for another year."

Nardone was so motivated by her love for Wrentham teachers that she and a friend paid for 50 lawn signs urging their neighbors to vote yes on the tax hike. With fliers warning that "your child will be affected by the override," she and other parents say that a defeat would spell doom in the classroom: Bigger class sizes, teacher layoffs, and the loss of programs like Spanish education and computer technology.

"I keep telling them, I agree with you; I don't want more taxes," Nardone said. "However, if you want police, if you want fire, if you want Wrentham on the map, you have to pay."

Matt Viser of the Globe staff contributed to this report.

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The Salem News
Friday, March 31, 2006

Weekly political column
By Nelson Benton


[ . . . ]

State Rep. John Keenan, D-Salem, is among those hailing the effort to lift the so-called "Lottery cap," which would direct all money raised by the Massachusetts Lottery to cities and towns.

The move, also recommended by the governor, has been endorsed by the House Ways and Means Committee. Combined with proposed increases in educational assistance, it would increase the amount of money allocated to municipalities by almost a billion dollars in the fiscal year that begins July 1.

The boost, as Keenan pointed out, couldn't come at a better time for Salem which is struggling with a multi-million-dollar deficit left over from the previous administration that has resulted in layoffs in the schools and other departments.

A major question, of course, is whether the Legislature will see fit to make the lifting of the cap permanent or retain the right to dip into the Lottery's growing pile of cash from time to time. The Massachusetts Taxpayers Foundation is already warning that the proposed increase in local aid eliminates "essentially all of the fiscal flexibility created by the recent strong growth in tax revenues," and says this level of assistance will be difficult to sustain in the future, especially if the Legislature approves a costly health-care program.

*      *      *

Speaking of the health-care bill, here's the Citizens for Limited Taxation take on the proposed House-Senate compromise:

"Adding a new $295 tax for companies that do not provide health insurance is adding another bad tax to an existing bad tax. Massachusetts should repeal the $62 (currently assessed against those who do provide insurance), and not assess the $295. ... If the final bill looks like the bill that is presently being floated, Governor Romney should veto it, then address it as president of the United States."

Nelson Benton's political column appears every Friday in this space.

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Health Care Bill:
Fearing The Worst [Politicus #890]
Thursday, March 30, 2006
By David Mittell, Jr.


Hillary Clinton and Ira Magaziner were widely criticized in 1993 and '94 for trying to remake the vast, anarchic financing of the American health-care system in secret, behind closed White House doors. With high-minded intentions, the first lady showed she didn't then understand the basic workings of the democratic process.

In Massachusetts in 2006, Salvatore DiMasi and Robert Travaglini -- respectively, the House speaker and the Senate president -- have made Mrs. Clinton's penchant for secrecy seem tame. With the first half of a two-year, $770 million federal Medicaid grant at risk of being forfeited if the state can't come up with a health-care bill in a matter of weeks, the two men shut out all but a few special interests from their many weeks of discussions.

Teaching hospitals have reportedly been in on the plan, as has the Massachusetts Taxpayers' Foundation, which, despite its name, represents big business. But the public doesn't know what's going on, rank-and-file legislators haven't known what's going on, and Governor Romney has been saying he doesn't know what's going on.

Finally, on April 3, Messrs. DiMasi and Travaglini held a press conference to announce the release of a 145-page bill, designed to increase the number of insured in the state, which the two of them now agree on. The House and Senate are expected to act quickly -- possibly voting by the time this article goes to press. Mr. Romney -- his governorship increasingly subordinated to the calculus of his ambition -- is not expected to veto a bill that would, for the time being at least, make him seem effective.

The purpose of the federal "demonstration grant" Massachusetts currently stands to lose is to encourage this state, then others in the future, to increase the number of citizens with health insurance. With a $385 million forfeiture betiding almost immediately, there will be enormous pressure on legislators to vote for the bill, and for Mr. Romney to sign it, without having much of a clue as to what's in it.

For the last four weeks the governor has been saying he could only speculate on what would be in the bill. He may have known more than he was letting on. But if he was kept even partly in the dark about what was being negotiated -- leaving the public, as we know, completely in the dark -- it was a travesty. A miscarriage of the democratic process, and with dangerous ramifications.

With its world-renowned medical and educational institutions, Massachusetts is the ideal think tank for innovation in the economics of medicine. But what we are witnessing -- conniving in secret, then voting under duress -- is the worst possible way to do it, with every likelihood of a fiasco the taxpayer will be stuck with long after this crop of political leaders has departed.

We may have a somewhat better idea of what the DiMasi-Travaglini agreement contains before the legislature votes. But we are not likely to have sufficiently debated its provisions, nor to have thought through its future ramifications. Based on my speaking with legislators and health-care activists, who could, of course, only speculate, here is the scenario I think we ought to worry about:

-- The bill is a sop to the powerful -- it protects big business and rewards big, profitable hospitals with big rate increases.

-- It does not protect small business and small hospitals. It introduces an initially small $295 tax per worker per year on the labor of businesses not providing health insurance.

-- It theoretically increases the number of insured, but has no way of assuring that the expanded coverage is reasonably comprehensive. It becomes, rather, a giveaway to insurance companies, and a bad deal for the newly insured.

-- It doesn't appropriate enough money to provide good insurance. Its mandate for expanded coverage thus becomes what one legislator called "the camel's nose in the tent." When, in a year or two, the new plan is broke, without doing enough for the formerly uninsured, it will need a massive infusion of new cash, including a big increase in the $295-a-year tax on the labor of non-participating businesses.

-- It creates a new bureaucracy with the impossible mandate of effecting top-down, bureaucratic "cost control." This entity doesn't control costs, but rather itself becomes a big cost.

I don't like to speculate and I don't like to be cynical about the work of fellow human beings. But the disgraceful lack of forthrightness by the leaders of the two houses and whomever they may have been confiding in leaves me to fear the very worst.

David Mittell is a regular columnist for the Patriot Ledger, the Providence (RI) Journal, and frequently others newspapers around Massachusetts.

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State House News Service
Monday, April 3, 2006

House, senate accord requires
big health insurance access expansion
By Amy Lambiaso


Nearly five months after beginning negotiations, House and Senate leaders on Monday afternoon outlined a bipartisan health accord aimed at covering 515,000 uninsured individuals within three years.

The bill requires all residents to buy or retain health insurance coverage by July 1, 2007 as long as affordable coverage is available, a determination that would be made by the state Department of Revenue. It is intended to deliver coverage to 95 percent of the uninsured, and does so in part by assessing both a new surcharge and a "free rider" charge on certain businesses not now paying for insurance.

The 145-page conference committee agreement will be put before the House and Senate Tuesday for up-or-down votes and could reach Gov. Mitt Romney's desk tomorrow. Legislative leaders said the bill is designed to control costs, expand coverage and maximize federal funding, and continue high quality care.

"This is a very historic moment in Massachusetts," House Speaker Salvatore DiMasi said during a press conference with members of the conference committee outside the House chamber.

Following the report's filing at 1:53 pm, DiMasi briefed his colleagues at a two-hour bipartisan caucus.

Two hours after lawmakers announced the accord, Romney called the press to his briefing room to congratulate legislators and identify the areas of similarity between what he proposed last year and a bill that lawmakers say may represent a model for the rest of the nation.

"The backbone of the bill is very much in line with what we proposed," the governor said, noting that he had not yet seen the entire text of the legislation. "The program to get everybody insured, with the idea of a personal responsibility principle, and dividing people in these groups as we have, and reforming the health insurance market is exactly what we proposed and that's what the bill does."

DiMasi cautioned that should the bill be signed into law, implementation will require cooperation across a spectrum, including the state and federal governments, health care providers and insurers, employers and individuals. Resistance from any group will threaten the bill's ambitious objective, he said.

"This is only the beginning," said DiMasi. "If people resist this bill, it will not be successful."

The program will cost $1.2 billion, although its supporters say the vast majority of that money, including federal revenues and assessments on employers and insurers, is already being spent in the system.

Conference committee negotiators say the plan requires $125 million in new state money for each of the first three years of implementation, along with $184 million in federal contributions. After three years, lawmakers say the plan will be "revenue neutral," meaning additional state money would not be required.

During the next three years, the plan calls for reduced reliance on the state-administered Uncompensated Care Pool, which reimburses health care providers who treat the uninsured. Pool payments are projected to fall from $897 million in fiscal 2007 to $680 million in fiscal 2008 and $480 million in 2009.

As dependency on the pool drops, the state plans to increase spending on insurance subsidies from $160 million in fiscal 2007 to $725 million in fiscal 2009, according to a balance sheet provided by conference committee staff. Additionally, the plan increases state spending on Medicaid from $150 million to nearly $360 million during that same time period.

The bills will cost $58 million this fiscal year, including start-up costs, investments in public health programs.

Hospitals and physicians will see a $90 million hike through fiscal 2009 in Medicaid payments, with those payments tied to performance measures during fiscal years 2008 and 2009.

"This is not the House bill, it's not the Senate bill, it's our bill now," said Sen. Richard Moore (D-Uxbridge).

Rep. Patricia Walrath (D-Stow) added: "We're just pleased that it's over with."

Lawmakers say they have worked with representatives of health plan associations, who say they will likely be able to develop a quality product for roughly $200 a month that will require a $1,000 deductible.

Those figures will be determined by the so-called Commonwealth Care Health Insurance Connector Authority, a new authority chaired by the Secretary of Administration and Finance that will coordinate delivery of new insurance products to businesses and individuals. The connector will submit cost estimates and product descriptions to the Legislature for approval.

A big question mark hanging over the bill is whether Romney will sign off on a new assessment on employers who don't offer insurance. Under the legislation, companies with more than 10 employees that do not offer insurance will be required to pay $295 per-employee into a state-controlled fund. All employers will be required to pay $62 a-head, a fee they are currently charged.

Additionally, if employees at non-offering companies do not purchase affordable insurance on their own and have their health care paid for under the Uncompensated Care Pool, their companies will be charged an additional assessment. That "free-rider" surcharge is applicable only if employees rack up a treatment bill of $50,000 collectively, and if an employee requires treatment at least three times.

When asked about the per-employee assessment, Romney said he does not consider it a tax. "It's not a tax hike. It is a fee. It's an assessment."

Romney added: "We are where we'd hoped we'd be, in a place where every citizen in Massachusetts will have health insurance, without a government takeover, without a big new tax program, and it's private, market-based health insurance. This is what we'd hoped to have and that's what we got."

Several conferees at today's press event admitted that they were surprised to be standing together with an agreement. Lawmakers, both in the conference committee and outside, said negotiations broke down several times since last November when the House and Senate passed different versions of a plan.

"I have to tell you all that I'm actually surprised that we're here," said conferee Sen. Brian Lees (R-East Longmeadow). "I want everyone here to know that there has been give and take on both sides."

On the House side, Republican conferee Rep. Robert Hargraves (R-Groton), also recognized the number of compromises that were required to reach a final agreement, but said the final product is one everyone should support.

"I will be supporting this bill right straight through," he said. "I might get some flack, I don't know."

At times, the negotiations were said to strain relationships between DiMasi and Senate President Robert Travaglini, who are longtime friends. Today, Travaglini joked about that evolution.

"When this began, I had six friends," he said. "I do not know if I'd put them in the same category today as they were when we began these discussions."

Lawmakers have sparred over the timing of the bill, with pressure from the federal government to withhold $385 million in Medicaid money if the legislation does not comply with provisions in a federal waiver. Federal officials have asked for at least 120 days to review the new plan prior to the July 1 implementation date; that time period has since passed.

Today, Romney said he was confident the plan would meet the federal government's requirements, but cautioned that reviewers are likely to have suggestions or changes to make.

"I'm pretty confident that we'll continue to be in line to receive support from the federal government," he said. "This is very much what we proposed to them and they found very attractive."

State leaders have also said they were told by federal officials that expanding the state's Medicaid programs would not be acceptable, but lawmakers have increased the income eligibility for children to receive MassHealth benefits to cover roughly 27,000 additional children. The plan also restores MassHealth dental and vision services, and coverage for chiropractic services and prosthetics.

When asked if the federal government will go along with those additional programs, Moore said other states have been successful in expanding those programs with the federal government's approval.

"They've already said they would approve that in other states," he said. "I don't know why they wouldn't do that for us as well."

The legislative plan establishes Commonwealth Care Health Insurance, an insurance program that offers subsidies to income-eligible residents. Premiums are set up on a sliding income scale, with residents earning less than 300 percent of the federal poverty level ($38,500 annually for a family of two) eligible. Those earning less than 100 percent of the poverty level ($9,600 a year for an individual) will not be required to pay a premium.

Under the bill, individuals will be required to purchase an affordable product by July 1, 2007. Beginning with income tax forms filed in 2008, residents will be asked to verify coverage and forfeit their personal exemption for that year if they have not purchased an affordable product. Some residents could be eligible for a one-year waiver of that penalty, lawmakers said.

After the first year, residents not purchasing affordable insurance will be charged one-half the cost of the most affordable product.

The Department of Revenue will be charged with writing regulations and overseeing many portions of the individual mandate's implementation. Several other state agencies, such as the Division of Insurance, the Division of Health Care Finance and Policy, and the Department of Public Health are also charged with writing certain regulations.

Because this is an appropriations bill, the governor has the ability to issue line-item vetoes to certain provisions, and offer amendments to individual provisions.

"I'd also note that by offering praise as I do for this day and this accomplishment, it doesn't mean that everything in the bill is exactly how I'd like it," Romney said. "My guess is that out of 140 pages, there may be something or more than something I'd like to change."

Additional highlights in the legislation:

  • Private market reforms to dictate coverage for 215,000 individuals;

  • About 207,000 uninsured to get subsidized Commonwealth Care coverage;

  • MassHealth expansions designed to insure 92,500 individuals by fiscal 2009;

  • Health care provider cost and quality information to be available to consumers through state board and web site;

  • Raises enrollment caps on existing programs, including MassHealth Essential, CommonHealth, and HIV programs;

  • Requires hospitals to collect and report on health care data related too race, ethnicity and language, with Medicaid reimbursements contingent upon providers reaching certain benchmarks.

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