This is the press release from the Department of Revenue that clarifies penalties for 2008. You might recall the law says that, beginning in 2008, individuals who don’t have health insurance would be fined up to half the cost of the lowest priced plan available. There was a lot of confusion about how much the penalties would vary based on things like age and where you live. DOR says this is an attempt to streamline the penalty schedule.
You can email comments to RulesandRegs@dor.state.ma.us.
One detail to keep in mind…the state will fine you next year (2008) based on the number of months that you go without health insurance.
As the need to control health care costs gets more attention, various groups have proposed specific cost containment goals. For example, the Connector Board (of which I am a member) voted to push insurers to limit rate increases for the unsubsidized Commonwealth Choice plans to no more than five percent for next year. A number of parties, including Health Care for All and Senate President Murray, have proposed holding rate hearings for health insurance premium increases at or above 7%. The Quality and Cost Council (QCC) has established a goal of reducing the annual rise in health care costs to no more than the unadjusted growth in Gross Domestic Product (GDP) by 2012.
These goals are ambitious and welcome, but theoretical. What would achieving such goals mean for people with private health insurance? I wanted to find out. So, I looked at the financial reports health insurers file with the Division of Insurance for the three largest private health insurers in Massachusetts—Blue Cross Blue Shield (including HMO Blue), Harvard Pilgrim Health Care, and Tufts Health Plan. I looked at reports for 2003-2006 and analyzed how much medical costs and health plan administrative expenses had increased for people with private insurance (i.e., I excluded the Medicare line of business). Since the Division of Insurance doesn’t require health plans to provide information for people covered by self-insured plans, the financial information that’s publicly available for the health insurers includes only people covered by fully-insured plans—about 2 million people for the three health insurers whose data I reviewed. I analyzed medical and administrative costs on a per member basis, to adjust for any enrollment changes at the health plans.
I assessed two different scenarios: Read more…
As I often remind people, health care is not just a necessity of modern life and the most personal and emotional of all services; at 16 percent of GDP, it is also the single largest sector of our economy. In Massachusetts, it is $60 billion a year and growing. So, you do not want to reform the financing of health care on a 51-to-49 vote.
Fortunately, the leadership of an overwhelmingly Democratic legislature worked with Republican administrations (in Massachusetts and D.C.), using the good ideas generated by academics and leaders in the private sector, to fashion a consensus for reform. It took nearly three years from the initiation of public discussion of achieving universal coverage and building coalitions to the spring of 2006, when every Senator and nearly every Representative voted for Chapter 58.
That was time well spent, not only to develop broad support for enacting Reform, but to build a base for implementing it. From the outset, we’ve said it will take another three years and the support of a broad coalition to fully implement Reform. Halfway through, we are celebrating the enrollment of some 300,000 newly insured. This is a worthy achievement, and I want to talk about how we got this far.
Commercial health insurance is what’s called a “grudge buy.” Read more…
An article in Wednesday’s New York Times describes a “new nuclear arms race” in medicine – the proliferation of nuclear particle accelerators for use in radiation therapy for cancer. The article encapsulates a significant challenge we face, in Massachusetts and across the country, in trying to bring the growth of health care costs and spending under control without cutting ourselves off from the medical benefits of new technology.
Proton beams created by particle accelerators are more precise than the x-rays typically used in radiation therapy, according to the article, and are therefore particularly valuable in treating tumors in the eye, brain, neck and spine, and for treating children. Ideally, the health care system would supply enough of this advanced technology to treat all cases where there is a clinical advantage in doing so, but not much more. Unfortunately, there are few mechanisms for ensuring optimal supply. The Times article states that much of the use of the five proton centers operating today is for treating prostate cancer, a use which, according to two radiation oncologists interviewed, is no more effective yet much more expensive than the latest X-ray technology.
The article reports that a dozen more proton therapy centers are being developed, spurred by market forces that include profit-seeking firms and local and state governments promoting medical tourism. Proton centers can cost more than $100 million to build, so it is reasonable to think that, once built, there is tremendous pressure to keep them busy. Medicare pays about $50,000 for proton treatment of prostate cancer, about twice what it pays for radiation therapy using X-rays. In short, proton therapy is, according to a companion article, a potentially very lucrative service. But someone’s lucre is someone else’s cost. Read more…
We are deep into December and facing all of the stresses that accompany the holidays. Yet along with shopping and feasting, the month presents an interesting challenge for those in the “sandwich generation” – baby boomers forced to address the needs of both their own children and their aging parents.
For many adult children, this time of year is characterized by family visits that can reveal physical and mental changes in their parents. Although free moments are limited, it is important that adult children address an often overlooked healthcare expenditure that is particularly evident during the holidays, the high financial and emotional cost of elder depression.
Amidst gatherings with friends and family, an older adult may view the holidays as a painful reminder of times past, with factors such as loss of independence, social isolation and financial limitations adding to the burden. With depression afflicting more than two million of the 34 million 65 and older, those with symptoms of depression have roughly 50% higher healthcare costs than non-depressed seniors. Yet as soon as regular care is needed, the burden falls to adult children. Read more…
The landmark Massachusetts health reform is fast approaching a key deadline: all residents 18 or older must be enrolled in a health plan by December 31st or face a penalty on their 2007 state income taxes.
As uninsured people scramble to find a health plan that fits their budget and meets their medical needs, it’s important to be wary of mass-marketed offers that seem too good to be true. For example:
• A fax received at work or at home promises health insurance—including prescription, dental, hospital and doctor visit coverage—for as little as $89.50 a month;
• A call from a telemarketer promotes a limited-time offer for a health plan with comprehensive coverage at very low cost, but pressures the consumer to pay an immediate enrollment fee in order to receive plan information;
• An internet search for affordable health insurance leads to web pages for low-cost plans that promise access to thousands of doctors, hospitals and pharmacies across the nation.
Offers like these should raise a red flag. Read more…
Finding new and effective ways to manage health care costs seems to be on everyone’s minds these days. With the recent announcement that our state’s historic health care reform efforts are exceeding everyone’s wildest expectations, there has been great excitement about our collective achievements — and yet growing trepidation about whether or not we can truly sustain this level of success.
Of course we can. In fact, we must.
One of the important things we must do to make reform a continued success is to work together to slow the health care cost trend in Massachusetts. Some solutions will take time to develop. Some apparent solutions may yield uncertain results.
However, the good news is that we know of a few simple proposals that we consider ‘low-hanging fruit’ if you will, that will yield tens of millions of dollars in health care savings – pretty quickly. By simply streamlining the way we do business, simplifying the backroom operations of health care, we can reap huge saving, while not cutting back on health care quality or access. Here’s how: Read more…
As we collectively enjoy the early successes of health care reform, a new trend in need of examination is emerging: A unique population is discernible in Commonwealth Care Plan Types III and IV — the partially subsidized, higher-premium plans available for individuals between 200 – 300% of the FPL.
The preliminary experience of managed care organizations (MCOs), which is consistent with Network Health’s participants, is that the Plan Type III and IV population is materially older than expected, and in need of significantly more medical services than the general population.
In fact, we are paying more than 150% for these members’ services than we receive from the state in premiums.
Clearly, Plan Types III and IV are not at all like traditional insurance plans.
This is not what anyone expected when Commonwealth Care was crafted. Read more…
According to press accounts, the Governor will be initiating a compact today aimed at health care costs and collaboration across state government. This is great news. On the heels of public statements by the Senate President, a promising new proposal presented by the health plans, and suggestions by the Connector that non-subsidized plans increases should be kept to 5%, this initiative by the Governor is most welcome.
May we be so bold as to make a few suggestions to the Patrick Administration, particularly to the Division of Insurance, the Health Care Quality and Cost Council, as well as the Attorney General?
Let’s require real, extensive transparency for all receivers of our health care dollars, from insurers to hospitals. But let’s make it meaningful and useful for everyone. Transparency has been proposed by all sorts of people and groups. But the vital issue is what is being reported and what will it do to not only lower overall costs, but to also ensure that health care cost distribution is fairer to all purchasers. A comprehensive transparency initiative should collect information which will set about the pathway to further reform efforts on behalf of consumers, employers and taxpayers.
It isn’t enough just to report the costs and outcomes of procedures, or even excessive executive pay at non-profits-although all that is vital. Read more…