We asked the creators of the Health Access and AFfordability Act to respond to the scenarios below. How would this plan help these people?

Scenario No. 1:

Wayne and Linda own a small breakfast place in Natick, Mass. They make between $25,000 and $29,000 a year for a family of two -- barely enough to cover their business and living expenses. They cannot afford health insurance. Linda recently had heart trouble and they're now faced with thousands of dollars in bills. They fear they will never "catch up" enough to even think about buying health insurance.

RESPONSE:

Currently Wayne and Linda are able to purchase small group health insurance coverage. Coverage is expensive, but at least in Massachusetts small group plans are required to cover everyone, even those with pre-existing conditions, such as Linda. The rates are not affected by her health status. In other states, people with health problems can't get any coverage.

Under the Health Access and Affordability Act, small groups like the Tylers would be eligible for several subsidy programs that would lower the cost of coverage. The "reinsurance" program calls for the state to pay the medical costs of people with large medical expenses. This lowers premiums, since the insurer doesn't have to cover high-expense patients.

A similar program in New York State has been very successful, lowering premiums by 15 percent or more. Though they would be over the income limit for MassHealth, they would also be eligible for the sliding-scale subsidy for people between two times and four times the poverty level. This subsidy is intended to avoid an abrupt cut-off of state assistance for people just above the MassHealth income limits.

SCENARIO No. 2:

Ernie is disabled and his wife Veronica works full-time as a parking attendant. When Ernie's SSI went up slightly, they were cut from Mass Health. Their children are still covered, but they are not. Veronica fears for Ernie's well-being, as he needs regular doctor visits.

RESPONSE:

Depending on Ernie's income, the increase in MassHealth financial eligibility limits will allow Ernie to be reinstated in MassHealth.

Scenario No. 3:

Colleen is 42 and single. She works 20-40 hours per week as a receptionist for an internet company and 24 hours plus hours a week as a computer specialist at a hospital. Her job offers no benefits. She can't afford the $500-800 per month to get insurance on her own.

RESPONSE:

By not offering benefits to their workers, in effect they are forcing taxpayers to shoulder the burden of covering Colleen's health needs. The bill would impose an assessment on both employers, charging them a few percent of their payroll. They could get out of paying the assessment, however, if they provided health care benefits to Colleen and her co-workers.

With this incentive, it will be in these companies' interest to start offering benefits. If the internet company is a small business (under 50 workers), they would be eligible for assistance in offering benefits to their workers, lowering their costs.

Scenario No. 4:

Jim has worked for 22 years with full benefits, but then he was laid off. He now works for a small construction company, which does not offer benefits. His COBRA benefits from his previous job have just run out. Jim had a heart attack recently and needs hundreds of dollars in medication each month, which he cannot afford.

RESPONSE:

Like Colleen's employer, the construction company would face the choice of offering benefits or paying an assessment to the state. Many construction companies today are caught in a bind, since they compete for contracts with rivals who don't offer benefits. This forces a "race to the bottom," in which every company drops benefits in order to remain competitive.

The bill will set a floor and require every company to either offer benefits or pay an assessment to the state. Like the minimum wage, this will allow companies to compete fairly -- without penalizing their workers. Small companies like Jim's will get the assistance they need to allow them to afford coverage.