Boston Bombings: Should the State Pay for Victims' Medical Expenses?

The almost 300 victims of the Boston Marathon bombing and their families will be able to rest a little easier knowing that they will receive insurance coverage for their treatment thanks to Massachusetts’ health insurance program, colloquially known as “Romneycare.” Enacted in 2006, the law requires all residents of the state to purchase health insurance, but also provides publicly subsidized coverage to those whose employer does not provide health care. Under the program’s Health Safety Net policy, those who cannot afford health insurance or who have inadequate insurance, as well as visitors to Massachusetts, are eligible to have their treatment costs paid for by taxpayers. The funding for Health Safety Net is primarily drawn from taxes on hospitals and health insurance companies, who in turn pass on this cost to their customers.

This arrangement will prove to benefit the victims not just during their initial treatment, but for their recovery, and in some cases the rest of their lives. As JudyAnn Bigby, former secretary of the Massachusetts Executive Office of Health and Human Services explained, federal law requires hospitals to treat emergency cases without any regard to ability to pay. But if the patient lacks (sufficient) insurance, hospitals will often send them to a public hospital or even home once their condition has been stabilized. With Romneycare, however, this is not an issue.

Furthermore, many of the victims will have long-term health problems due to their wounds. Elsewhere in the country, this might mean they would have “pre-existing conditions,” making it difficult to find insurance plans willing to cover them. The Massachusetts health care program is limited in this regard: Depending on the nature of the injuries and their subsequent related costs, victims’ long-term care needs may or may not be covered by their insurance, whether it is private or public. Numerous charitable funds have been created precisely to deal with this problem.

While lower health insurance costs and greater coverage are hardly a bad thing, Romneycare has had its fair share of criticism. For one thing, it failed to decrease emergency room usage: There was “a 6% increase in emergency room use from 2006 to 2010, the first four years when the law was in effect.” There was also an increase in demand for public “safety-net” hospitals, contributing to increased difficulty in seeing a doctor: “the Massachusetts Medical Society found that only half of the state’s primary-care providers are accepting new patients, down from 70% in 2007. And the average wait time to see a doctor in family medicine is 45 days — up from 34 days in 2007.”

Romneycare’s success with two main goals — achieving universal coverage and lowering health care costs — seems mixed. According to the Blue Cross Foundation, the percentage of low-income adults who lacked insurance fell from 24% to 8% after the law was enacted. Furthermore, the cost of premiums for families rose about 19%, compared to 22% for the whole country. On the subject of cost to the taxpayers, the results are mixed, and still unknown. Former Congressional Budget Office Director and President of the American Action Forum Douglas Holtz-Eakin claims that health care costs per capita were 27% higher in Massachusetts than in the rest of the country in 2004, two years before the state plan was signed, and that by 2009, they were 30% higher than the national average. The Cato Institute’s Michael Tanner claimed that the program was expected to cost $1.8 billion in 2008, but would exceed those estimates by $150 million, and that over the next 10 years the program could cost $2 billion more than the budgeted amount. According to Michael Widmer, president of the Massachusetts Taxpayers Foundation, however, Romneycare cost an extra $100 million per year. Yet the same organization is cited by a pro-Romney website as showing that the average yearly increase in costs was only $88 million. This is only a taste of the contradictory, mixed evidence regarding the program’s outcomes.

While it is clear that the victims of the Boston bombing are likely to benefit in some way, the exact nature of this benefit — and of the effects on taxpayers — seems unclear. There are reasons to be both optimistic and skeptical. That said, regardless of people's personal views regarding the proper solution to our country’s struggle to provide accessible, affordable care, it ought to be clear that solutions like Romneycare or the Patient Protection and Affordable Care Act are mostly band-aid solutions. Real health insurance reform will address the fundamental issue of why costs are so high.