We all make assumptions, and the soundest assumptions help us move forward when forging a brand new path. They are temporary beacons and light the way for a very short distance. So, here are a few lessons learned by the Connector board based on our initial assumptions that will help us see our way to next steps:
We assumed that there were only 380,000 uninsured in Massachusetts.
Seems that there may be many more than that low estimate. Maybe the Urban Institute was closer with their estimate of 500,000.
We assumed a modest expansion of Medicaid.
One year later, Medicaid is covering an additional 45,000 residents.
We assumed that only 60,000 would be eligible for Plan Type 1 (those making under 100% FPL and with a premium that the state pays completely).
And that we would consider signing up 54,000 as a great success. We have already signed up over 63,000 in Plan Type 1 and are greatly outpacing this assumption.
We assumed that 59% of the uninsured were 34 or younger. We assumed an individual mandate would get these people to buy insurance.
The only group that matches our projections is in Plan Type 1, where we automatically signed up everyone.
This means we need an adjusted projection: What will be the cost of treating an older population?
We assumed there was the provider capacity to treat all of these people.
About 150,000 people are now newly covered. They came into the system in only 8 months, so it is no surprise that it takes a long time to get a primary care doctor. How do we support our healthcare system so that meet the needs of everyone?
The costs providers are charging are going up for many reasons. The state decided to pay them more with Medicaid rate increases. There is hot competition for primary care doctors and neighborhood health centers. “Unit prices” are going up quickly.
The issue of provider rate increases has never been more critical. We need our Cost and Quality Council to get to work on this issue immediately.
We assumed that by using “competition” we could force insurance rates down permanently.
By promising the lion’s share of patients to the Medicaid Managed Care Organizations with the lowest rates, the Connector hoped to keep their premium cost down. This resulted in premium costs for MMCO plans that are lower than the BCBS bid for minimum creditable coverage – an insurance product that has higher deductibles, co-insurance, and larger out-of-pocket costs (one whose premium cost should be lower because individuals will pay more out of pocket). This makes no sense. Either BCBS is being paid too much for their Bronze plans, or the two largest MMCOs are paying too little for their coverage of the poor! The problem of costs is complicated, and we will have to better understand the real cost drivers as we go forward.
As we look to the future, we need to re-examine the process behind these assumptions, to understand if we have a “cost” problem, or an assumption problem. If we only tackle costs, but not our underlying assumptions, then we are guaranteed to repeat our mistakes.
Celia Wcislo is a member of the Connector board
and Assistant Division Director, 1199 SEIU
Please fail. And then we can do away with this unfair, unjust and illegal mandate.
And I am sick and tired of being called “these people”. I am not part of the problem, you are.
Ms. Wcislo,
This is entirely the problem with Chapter 58. It was crafted and passed based upon so many erroneous assumptions.
“When you assume, you make an ass of YOU and ME.”
Unfortunately, the “ME” are that hardworking taxpayers and families of this potentially great state.
I can’t believe that in a country that can put humans in outer space for years at a time, in a country that can waste TRILLIONS of dollars (taken from children’s mouths and stripped from the backs of citizens) on a greedy “war”, that there is not the technical knowlege, the financial means or the circumspect wisdom to devise an honestly useful heathcare plan.
Yes, greed and political gain-lust are disturbing human frailties. These qualities will lead to abject failure of this enterprise and make Massachusetts a wretched laughingstock. And all at the expense of our citizens.
Ms. Wcislo, please keep looking. Open your eyes to this folly.
“Pride comes before the fall.”
“And I am sick and tired of being called “these people”. I am not part of the problem, you are.”
Calling all healthcare justice activists:
If you’re not part of the solution than you’re a part of the problem!
Please join the solution at
http://www.defendhealth.org
and
http://www.MassCare.org/about
And on the national level at
http://SickoCure.org
Dear Ms Wcislo ,
Please dare to respond to these comments – unlike Nancy Turnbull in “A Quiz on Health Reform in Massachusetts by Nancy Turnbull”
Posted by CommonHealth, Wednesday, July 18th, 2007
I totally agree with Pat! The State has made being “uninsured” something to be ashamed of. We are sick of being singled out like we have an affliction. The problem is the greed with the insurance industry and it’s ties with the State House. Politics and medicine do not mix. I am a American citizen and will not be singled out because I am “UNINSURED”
To clarify my above comment, I totally agree with Pat and also with what Norma says in her powerfully (and painfully) accurate comment.
All readers should be aware that the relatively few commentors here represent the opinions and sentiments of HUGE NUMBERS OF PEOPLE ACROSS THE STATE and across the nation. There is a growing social movement to demand guaranteed universal healthcare with improved Medicare For All.
I am so ashamed that we as a Commonwealth and we as a nation do not yet have this in place.
–
There is something that you can do RIGHT NOW to help. Click the below link to sign a Petition to Congress to enact a Guaranteed Healthcare Program, then sign up to receive updates and more opportunities to take positive action. Thank you.
http://www.democracyinaction.org/dia/organizationsORG/PNHP/petition.jsp?petition_KEY=629&t=SickoCure.dwt
Everyone who advocates any national healthcare policy should look more closely at Great Britain, Germany and Canada. On the surface it looks great. But Americans have become spoiled to the idea that every test must be done and they must all be done NOW! You will no longer be in the driver’s seat. We know how poorly the government programs reimburse physicians. Under a universal system it will only get worse. Hospitals and physicians will no longer be able to afford to invest in state-of-the-art equipment. Fewer people will choose to become physicians so access will be even more of a problem. In about 10 to 20 years, when the equipment we have now is insufficient to take care of the increasing population, you will be waiting 6 months for your CT scan or 6 months for your coronary bypass. Some of you won’t live that long. There are no easy answers to this broken system, but relying on Uncle Sam to take care of us is NOT the way to go. Perhaps some of the “non-profit” insurance companies (like Blue Cross) could cut back on the multi-million dollar salaries they pay their CEO’s and put that towards reducing premiums. That would be a start.
One more thing – Norma said it perfectly . . . “politics and medicine don’t mix.” Amen to that! The rules and regulations the government has imposed on the healthcare system goes hand in hand with what they greedy insurance carriers have done to drive costs up and access down. Unfortunately, we’ll never see Marcus Welby days again.
Susan, some of your points are valid but I strongly disagree with your conclusion that improved Medicare For All is not the best policy to guarantee affordable healthcare for all. We do need better standards, oversight, and accountability in a national health program, but we’ve got to move forward and join the rest of the civilized industrialized world by enacting a national health program.
Don’t be duped by the scare-tactics to block this kind of sensible Medicare For All reform. We are all susceptible to being force-fed and influenced by this fear-mongering garbage, promulgated largely by the insurance and drug co. industries, and by some physician groups as well(the AMA comes to mind – double shame on them).
Re: “We know how poorly the government programs reimburse physicians”
Actually, no, we don’t. Some kinds of docs are lower paid than others and that’s where the correction needs to occur.
FYI The national medical student community in the U.S. is a beacon of hope for all of us. The American Medical Student Association (AMSA) left the AMA years ago in response to AMA putting individual MD fortune-making before patient and communities’ needs.
AMSA is helping to lead the way to an effective, affordable and humane national health program, modeled on improved Medicare For All. They understand that the fake reform law C. 58 passed in MA, with it’s punative and unworkable “individual mandate” is a harmful obstacle to needed reforms. AMSA is educating medical students here in MA and in every state across the country about these realities and how to take action for Medicare For All.
For people who want to understand the facts of health policy and reform, in addition to insurance industry rhetoric, AMSA has excellent online resources on universal healthcare at this link http://www.amsa.org/uhc/
I agree with Ann.
The “Big Dig”, Katrina and all of that scares people. We can’t do better? Of course we can.
There is nothing impossible about high standards and accountability. We can learn from the lessons of others and of the past.