In Massachusetts, Insurance Mandate Stirs Some Dissent

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BOSTON — Wayde Lodor is part of the 2 percent: the roughly 120,000 residents of Massachusetts who lack health insurance despite the state’s landmark 2006 law requiring almost every adult in the state to have it. He is likely to face a penalty this year, having made enough money under the state’s guidelines to afford a health plan. But Mr. Lodor, an independent product development consultant from Leominster, remains defiant.

Gretchen Ertl for The New York Times

Wayde Lodor has refused to buy the health insurance required under Massachusetts law.

By ABBY GOODNOUGH

Published: March 27, 2012

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• Graphic : Massachusetts Residents Who Don't Comply With the Health Coverage Mandate

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Gretchen Ertl for The New York Times

Ronn Garry Jr., a grocery store owner, faces penalties because too few of his employees have opted in.

"I’m in good shape, I don’t eat meat, I don’t drink excessively, I’ve never smoked," said Mr. Lodor, 53, who estimates he would have to spend at least $1,200 a month to cover himself and his college-age daughter. "The last thing I’m going to do is not pay my rent because I have to pay for some state-mandated health coverage that I don’t think I need."

As the Supreme Court hears arguments this week on the constitutionality of the national health care law and its requirement that most Americans be insured or pay a penalty, Massachusetts offers a real-world laboratory of how such a mandate might work.

Roughly 48,000 people in the state were subject to penalties for not having coverage in 2009, the latest year for which figures are available, down from 67,000 in 2007. The maximum penalties range from $228 to $1,212 a year, depending largely on income. (Anyone with an annual income of less than 150% of the federal poverty line pays no penalty.) The penalties are paid on state tax returns.

Massachusetts health officials say the shrinking number of violators is a sign that the law is succeeding. "I think the individual mandate in Massachusetts has been accepted by our population, understood, and broadly judged as fair," said Glen Shor, executive director of the Massachusetts Health Connector, the state agency that helps residents find insurance coverage.

But for the relatively small universe of people who resist buying coverage, the mandate is a bitter pill. Teofilo Cuevas, 51, who earns about $40,000 a year as a meat cutter at a grocery store, said he had decided to drop his employer-provided coverage because even with insurance, he could not afford his out-of-pocket costs. He said he avoided going to the doctor.

"A lot of people cannot pay this," Mr. Cuevas, an immigrant from the Dominican Republic, said through an interpreter.

For individuals facing penalties, who are often young, male and healthy, the state appears to have been generous in granting one-year waivers. From 2007 through 2010, the state approved 65 percent of the appeals filed by people who had been given penalties, or 7,163 out of 10,992, according to the Health Connector. State officials said appeals were granted based on proof of financial hardship, which might involve unemployment, a foreclosure or period of homelessness, or having to make the choice between paying for insurance or for heat and electricity.

"It’s a very humane and fair appeals process that gives people the opportunity to tell their story in full," Mr. Shor said.

But some small business owners also feel unfairly targeted by the law, which requires employers with the equivalent of 11 or more full-time employees to offer coverage or pay a penalty of $295 per employee. Mr. Cuevas’s employer, Ronn Garry Jr., owner of Tropical Foods, a grocery store in the Roxbury section of Boston, is facing nearly $30,000 in penalties because not enough of his 70 employees signed up for his employer-provided plan over an 18-month period, he said. "It’s frustrating," Mr. Garry said of the law, "because I support it but I also feel victimized by it."

He added, "Most people want to have coverage but they have to make dollars-and-cents decisions."

Over all, 4.6 percent of the employers who are required to offer coverage, or about 1,000, were penalized for noncompliance in 2010, according to the state. The state’s Division of Unemployment Assistance enforces the rule; compliance improved to about 95 percent from about 88 percent from 2007 to 2010. Money from the penalties helps offset the cost of state-subsidized health insurance.

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