Earlier this week, The New York Times published an article that rightly laid out the challenges of government mandating insurance coverage to its citizens. I agree with the comments made by Diane Rowland, executive vice president of the Henry J. Kaiser Family Foundation, a non-partisan organization that focuses on health care policy analysis and large-scale public heath information. She said “that an individual mandate is the only alternative to government provision of coverage if you hope to achieve universal coverage.”
Universal coverage has been the goal of Massachusetts’ health care reform efforts from the very beginning. Our experience is reflective of a profound social revolution with the fits and starts of any worthwhile, ambitious undertaking. Right now, we in Massachusetts are at the first real critical juncture of the implementation of health care reform: having our citizens enrolled by year’s end, before they suffer a financial penalty. The good news is that Commonwealth Health Insurance Connector Authority claims that enrollment is exceeding expectations. Health plans such as Tufts Health Plan want to make it as easy as possible for people to enroll, and as a result, Tufts Health Plan is suspending usual operational requirements so that any individual who enrolls with us through our individual channel by Dec. 31 will be covered and thus, able to avoid the 2007 penalty.
The bad news is that for many, health insurance continues to be a “grudge purchase,” with people hedging their bets that illness won’t strike or accidents won’t happen. Read more…
People as old as I am may remember in the 1970s, as we faced the end of the Vietnam War, discussion of a “peace dividend,” a nice monetary boost from decreased military spending that could be used for education, health care, economic development – you name it. Well – 1974 turned into a big recession year followed by a staggering energy crisis, and pretty soon, everyone forgot about the “peace dividend.”
People not as old as I am may remember – during legislative discussions of health reform – talk by insurers and others of a “coverage dividend,” premium savings that would flow to businesses and individuals because expanded coverage would end cost shifting embedded in everyone’s premiums to finance care for the uninsured. Before we completely forget about it, I have to ask the state’s health insurers:
What happened to the “coverage dividend?”
We know health insurance premiums are increasing 8-12% next year, well about the national average increases of 6-7%. We know many businesses who are facing increases in excess of 20%. We know these increases are the most destabilizing force in undermining health reform’s success.
Forget about a “coverage dividend” … are we paying a “coverage penalty?” What’s going on here? Read more…
IF YOU ARE WHITE AND WELL EDUCATED IN MASSACHUSETTS…YOUR HEALTH IS GENERALLY GOOD…ACCORDING TO A STATE REPORT OUT TODAY. BUT IF YOU DIDN’T GRADUATE FROM COLLEGE…YOU DIE YOUNGER THAN RESIDENTS WHO DID. AND IF YOU ARE BLACK OR LATINO…YOU FACE MORE HEALTH PROBLEMS IN JUST ABOUT EVERY CATEGORY, ON AVERAGE, AS COMPARED TO WHITES. JOINING US FOR A LOOK AT WHO’S HEALTHY, WHO’S NOT AND WHY, IS SECRETARY OF HEALTH AND HUMAN SERVICES, JUDYANN BIGBY.
One of the more thoughtful perspectives on health insurance mandates is published in the current issue of Health Affairs titled “Consider it Done? The Likely Efficacy Of Mandates For Health Insurance”, written by Sherry Glied, Jacob Hertz, and Genessa Giogi.
In presenting both the benefits and the challenges of using mandates to expand coverage, the authors make the observation that health insurance mandates are attractive to policy makers for the following reasons:
· “Mandates offer a way to address the problem of those who are already eligible for public programs but fail to obtain coverage, thus making coverage a more urgent concern.
· Mandates level the playing field, forcing employers or individuals who have been using publicly funded services to pay their fair share of the cost of coverage.
· Mandates can reduce the need for explicit public funding of new coverage, by substituting funds generated through the mandate for tax funds.
· Mandates can ease insurers concerns that only less healthy people will choose to participate in a new voluntary insurance program.
· And mandates can act as a legislative self-control device, binding the government to provide adequate subsidies to make compliance feasible.”
They note there are already in place a number of mandates outside of heath insurance that have existed for years including: automobile insurance, individual income tax (we don’t typically see income tax as a mandate, but it is), child support, childhood immunization, and minimum wage laws. Read more…
Keene, NH – November 27, 2007 – Former Governor Mitt Romney is campaigning at a health care forum in Saint Petersburg, Florida, this morning. On the presidential campaign trail, Romney has played down his role in pushing through the nation’s first law that requires people to get health care coverage.
Now, he’s beginning to tout his accomplishment, and says he’d like to see similar coverage across the country. The change comes as Romney’s main rival in the New Hampshire presidential primary, Rudy Giuliani, is beginning to spend more time there.
WBUR’s Fred Thys has been following Romney in New Hampshire, and has this report.
TEXT OF STORY:
FRED THYS: Romney is talking to a crowd at a recreation center in Keene. He’s asked why he wants to run for president, and he uses the opportunity to talk about health care.
MITT ROMNEY: And I want to go to Washington and get better schools and health care for all of our citizens.
THYS: Someone in the crowd asks Romney how he thinks he’s going to be able to work with a Democratic Congress, and he talks about his experience passing the health care law on Beacon Hill. He looks ahead to the general election.
ROMNEY: And then there are times when you can find common ground, where good Republicans and good Democrats can say: “There’s a place where we can work together,” and that happens a lot more in states than it happens in Washington. We’ve gotta bring some of that state attitude to Washington again. We did that in our state by getting everybody health insurance. The plan we came out with isn’t perfect, but it’s getting everybody in our state insured. It doesn’t require new taxes or a government takeover. It’s not Hillarycare. We’re not goin’ there, but I’m pretty proud of what we did, Republicans and Democrats working together.
THYS: Romney is in a comfortable position in New Hampshire. The latest University of New Hampshire poll, released this month, shows him with a 12-point lead over Rudy Giuliani. Among likely voters in the Republican primary, health care is way down the list, behind Iraq, the economy, illegal immigration and taxes, but among likely voters in the Democratic primary, the poll finds health care is the most important issue. Romney is now trying to show that he can beat the Democrats at their game. Jennifer Donahue, of the New Hampshire Institute of Politics, says Giuliani, whom she followed yesterday, is emphasizing 9/11. Meanwhile Romney is trying to show that he can debate the Democrats across a broader spectrum of issues.
JENNIFER DONAHUE: I think right now what you’re seeing is Romney and Giuliani in a very tough fight, not so much a tough fight in New Hampshire, where Romney is doing better, but nationally, and in terms of image, who can beat Hillary Clinton? I think that’s the question that people are looking at and weighing these two candidates through.
THYS: In Keene, another person in the crowd asks Romney whether he or Rudy Giuliani would be the best candidate to beat Clinton in the fall of next year. Romney says that in the general election, the value to Republicans of having Giuliani as their candidate in big states such as New York, is dubious because, Romney believes, New York is likely to go to the Democrats anyway. Romney argues that come November 2008, he’s the more likely candidate to win what he calls the purple states, such as New Hampshire, Michigan, and Ohio. Once again he brings up health care to make that argument.
ROMNEY: So I look forward to debating Hillary Clinton. I can’t wait to talk about health care, for instance. I think I’m the only Republican out there with a plan that gets everybody insured. My plan says upon passage of my plan, in four years, we’ll have all the citizens of this country insured without having to spend 110 billion dollars which is in Hillary’s plan. I could talk face to face with Hillary Clinton on our different approaches for getting people insured.
THYS: Throughout this campaign, Romney has made it clear that he would not impose the Massachusetts model on other states, and in an interview with WBUR after the Keene event, he maintains that position. But it’s clear these days that he wants to try to get all Americans insured.
ROMNEY: I would like to see every other state in America take action to get all of their citizens insured, and would use federal incentives to encourage that type of reform state by state. I would not impose on every state the exact answer we had in Massachusetts, because the states are different, but I would use the resources of the federal government to encourage and incentivize reforms to get all of our citizens insured.
THYS: Romney would allow states to use federal Medicaid dollars to buy insurance for people instead of reimbursing hospitals for free care. We were unable to get any more details from him or his staff. But the tone of the campaign is now a very different one from when Romney was playing down Massachusetts’ health care law and his own role in getting it passed.
For more than two years, many of us have been working first to pass, and now to implement, health care reform. But making health care reform work in the long run will require holding down costs. And that will require engaging everyone in an effort to promote healthy lifestyles.
One example of what I’m referring to is childhood obesity, which I’ve been talking and writing about quite a bit lately.
One in four Massachusetts high school kids is overweight or at risk of becoming overweight. Those students are more at risk for heart attacks, strokes, diabetes and other serious diseases later in life. And their medical status will drive up the health care costs for them and everyone else in the health insurance risk pools. Nationally, obesity adds $90 million to medical bills every year.
Dealing with this problem will require a broad and constant effort on all of our parts. We need to support funding for physical education and after-school athletics. Read more…
What can I give back to God for the blessings he’s poured out on me? I’ll lift high the cup of salvation—a toast to God! I’ll pray… I’ll complete what I promised GOD I’d do, and I’ll do it together with his people. … I’m ready to offer the thanksgiving sacrifice..”
Psalm 116:15-19 (The Message)
During this Thanksgiving holiday season, we in Massachusetts, have much for which to be thankful. As it relates to healthcare, over 200,000 residents of this state, who were previously uninsured, now have quality health insurance through Commonwealth Care or MassHealth. This is due in no small measure to the historic and bold efforts of state officials, businesses, community and religious groups responsible for the creation of Chapter 58.
Laverne Barnes, a leader in my own church, now has quality insurance through Commonwealth Care and was able to receive a life saving surgery several months ago. She represents the many across the Commonwealth for whom affordable, accessible, quality Health Insurance has truly meant the difference between life and death. Surely among the 200,000 previously uninsured are those who would lay claim to the words of the Psalmist, “I’ll lift high the cup of salvation – a toast to God!” I would add a toast to all who worked so hard to make this historic reform possible, and a toast to all who are working so hard on enrollment and implementation. Read more…
MASSACHUSETTS’ LANDMARK EFFORT TO COVER THE UNISURED IS BUILT ON THE PREMISE THAT INDIVIDUALS, COMPANIES AND THE GOVERNMENT SHARE RESPONSIBILITY FOR THE SUCCESS OR FAILURE OF THE LAW. THE FIRST NUMBERS ON WHETHER EMPLOYERS ARE DOING THEIR FAIR SHARE ARE IN…BUT THE QUESTION IS NOT SETTLED.
BEBINGER: The law says employers have to report how many workers they have and how much, if anything, they contribute to health insurance. Those with 11 or more employees, that don’t meet state coverage standards, must pay a $295 fine for each worker. Jim Klocke, executive vice president with the Greater Boston Chamber of Commerce says the first round of employer reporting is very encouraging.
KLOCKE: These show that we have very strong employer participation in health insurance in Massachusetts. 97% of the companies who have filed are in compliance with the new law.
BEBINGER: The numbers are preliminary…about a third of the firms in the state have not yet filed. Those 21,000 companies will receive reminder notices next week. If they don’t file by early next year, they will be fined. Some health care consumer advocates are suspicious that there only 518 firms so far that don’t provide health insurance. The fines for those firms total 5 million dollars. When the bill passed, the legislature estimated the $295 penalty would raise 48 million dollars. Health Care for All Director John McDonough.
The fact that employers aren’t generating the level of revenue anticipated, means that there is a higher burden falling on the state’s taxpayers and the state’s general fund.
BEBINGER: Business groups says estimates about how much this fine would raise were based on speculation. But some legislators who wrote the law say businesses are getting off too easy. Read more…
Here’s the press release from the Patrick administration – what do you think?
Regular readers of this blog are quite familiar with the emerging discussion about health care costs in Massachusetts, a discussion which has focused mostly on the sustainability of health care reform in the face of rising premiums and higher than expected CommonwealthCare enrollment. Rick Lord, CEO of Associated Industries of Massachusetts (AIM), yesterday captured the growing consensus in the Commonwealth: “We’ve made great progress in Massachusetts expanding access to coverage, but we have to tackle the second phase of health care reform – we have to control cost increases or our reform is not sustainable.”
At the same time, a parallel national debate is intensifying over similar pressures facing the federal Medicare program. A recent Congressional Budget Office report suggested that answers must be found that improve the value of health care: “Substantial evidence exists that more expensive care does not always mean higher quality care. Consequently, embedded in the country’s fiscal challenge is the opportunity to reduce costs without impairing health outcomes overall.”
As we attempt to sustain health care reform, we must seek similar solutions: reducing costs while continuing to improve health outcomes. Read more…