Massachusetts House Speaker Salvatore DiMasi (D) and state Senate President Therese Murray (D) are considering an increase to the state's cigarette tax as one of several proposals to address the greater-than-expected costs of the state's health insurance law, the Boston Globe reports. DiMasi and Murray are examining several different options to ensure that the initiative is successful in light of recent projections that subsidized coverage under the law could cost as much as $1.35 billion by June 2011, according to the Globe. A $1-per-pack cigarette tax increase could generate $152 million annually, according to estimates by the Campaign for Tobacco-Free Kids.

However, legislation to raise the cigarette tax has "languished" over the past year and the New England Convenience Store Association is expected to strongly oppose any effort to increase the tax, the Globe reports. Murray also is considering efforts to reduce costs by streamlining billing, expanding primary care services and hearings regarding insurance rate increases. In addition, state lawmakers will consider increasing the penalties that businesses must pay if they do not offer health insurance to employees (Dembner, Boston Globe, 2/6).

Opinion Piece
As the debate continues across the country over whether all U.S. residents should be required to obtain health coverage, "the question in Massachusetts comes down to this: Have we promised more than we can deliver?" Globe columnist Steve Bailey writes. According to Bailey, the first part of the state's health care reform, "hard as it was, was the easy part" because "[a]lmost everyone was a winner," but the second part -- "controlling costs -- will involve harder choices, and will produce losers as well as winners."

Bailey writes that in order to control costs, the "health care delivery system itself ... must be restructured" and that the "best solutions will come from a remaking of the health care delivery system that emphasizes incentives for lower costs and improved quality." Bailey writes, "Massachusetts did what no other state was willing to do because it got tired of access being held hostage to cost," concluding, "But broadening coverage without slowing costs will not work. In the end, it will break the bank" (Bailey, Boston Globe, 2/6).

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