Due to a massive budget shortfall a Massachusetts panel proposed cost cutting measures which included cutting roughly 30 thousand legal, taxpaying immigrants out of the state subsidized Commonwealth Care program.

They also proposed scrapping traditional payments to doctors and hospitals for each office visit or procedure, and instead adopting a system where they receive a monthly or annual fee per patient.

Under the proposed new system, doctors and hospitals would be organized into groups responsible for all of a patient's health-care needs. The groups would receive a "global payment" per patient, which could be adjusted with performance incentives based on the quality of care provided. They would also require legislative action and waivers from Medicaid and Medicare rules.

The state's health-care costs are among the highest in the nation and this is said to be the result of a health-care law that Massachusetts adopted in 2006 which has given near universal health insurance coverage.

Although the plan has become a model for national health plans that are now being revamped in Congress, but it has cost the state 33% more than the U. S. average and is projected to grow faster than the rest of the country.

The commission included key state legislators, the state's leading doctor and hospital associations and insurers and the panel, created by state law, unanimously voted to adopt the recommendations.

The commission said the current fee-for-service payment system "rewards overuse of services" and is "a primary contributor to the problem of escalating costs and pervasive problems of uneven quality." It said the "global payments" model provides for better coordination, and encourages "the efficient delivery of the full range of services that most patients need."

Insurer Blue Cross Blue Shield of Massachusetts issued a statement urging the state's lawmakers "to take swift action to turn today's recommendations into law."

The proposal to cut thousands of legal immigrants from the state's universal plan will save an estimated $130 million a year. "We cannot commit to how can we solve this problem because we don't know if we're going to hit the revenue benchmarks we've planned this year's budget on," Rep. Bradley Jones, Jr., Massachusetts House Minority Leader said.

However critics of the cuts said those left without insurance will resort to the only option available to them. "They will end up waiting until they get sicker, show up at emergency rooms, be incredibly expensive and those costs will often fall to the hospitals where people are being treated," said Lindsey Tucker, health reform policy manager at Health Care for All.

Governor Deval Patrick said the state made a commitment it ought to keep and is urging the legislature to pass a compromise measure that would still offer some form of coverage to immigrants.

"We're talking about hardworking taxpaying residents who are contributing to the system and we think it's only fair that healthcare for all is really for all," Patrick said.

Mario Motta, president of the Massachusetts Medical Society, which represents the state's doctors, urged lawmakers to proceed "carefully, deliberately and thoughtfully" and said doctors "will have many questions and concerns about this proposal."