Less than three years into implementation of Massachusetts’ law requiring all citizens to prove they have health insurance or pay a $1,000 average fine, the state continues to scale back health coverage for the lowest-income residents who receive state subsidies for private insurance. In the Boston Globe:

Overseers of Massachusetts’ trailblazing healthcare program made their first cuts yesterday, trimming $115 million, or 12 percent, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of the 2006 law.

The board of the Connector Authority made the cuts as officials confronted two side effects of the recession: the state budget crisis and a surge in enrollment by the recently unemployed.

The largest share of the savings will come from slowing enrollment. An estimated 18,000 poor residents who qualify for full subsidies, but who forget to designate a health plan, will no longer be automatically assigned a plan and enrolled and thus could face delays in getting care.

Small wonder that the state can’t afford to continue subsidizing all of the uninsured, when their coverage is provided through private insurers who made no concessions to affordability in the creation of the plan. Premiums for Massachusetts’ state-subsidized health plans for low-income consumers increased 10% after the first year, and today’s announcement occurred simply because more people were signing up (despite the state dodging a premium increase this spring).

If Massachusetts, where they started with fewer uninsured, mostly non-profit insurance companies, insurers must cover everyone regardless of health condition, and average income is significantly higher than it is nationally, cannot afford a mandate because they failed to rein in the insurance industry, a national mandate will crash on take-off without a public plan alternative and strict new rules to start holding the insurance industry’s feet to the fire.