Health Reform Winners and Losers
A year into health reform, its starting to become clear who the winners and losers will be.
Winners:
1- Health insurance firms hit the jackpot. The state is set to force hundreds of thousands of people – mostly near-poor and lower-middle class – to pony up for private coverage. The $1 billion or more in new business – and the promised end to private insurers’ indirect contribution to the Free Care Pool – virtually assures healthy profit growth.
2- Very poor citizens get upgraded and expanded coverage. Though all of them were previously eligible for Free Care, some will find the new coverage more flexible and easier to use. But for some, the copayments for drugs and emergency visits in their new plans will mean even worse care than before.
3- Hospitals that serve few of the uninsured. They’ve gained higher reimbursement rates from Medicaid, and big savings from the phaseout of their contributions to the Free Care Pool.
4- Politicians who are posing as innovative leaders in solving the health coverage crisis.
Losers:
1- Uninsured immigrants. This group – especially immigrant children – already gets shockingly little care (about half as much as the native-born uninsured). They’re ineligible for the new subsidized coverage, and will find care harder to get as the demise of the Free Care Pool squeezes safety-net providers.
2- Safety net hospitals and clinics. With the end of the Free Care Pool, these institutions will be in deep trouble. It is now clear that many patients will remain uninsured despite Chapter 58, but private insurers and affluent hospitals are soaking up the funds that previously paid for the uninsured.
3- Low income patients forced to empty their pockets paying for defective insurance policies. High deductibles and co-insurance mean that many will pay hundreds or even thousands on premiums, and yet be unable to afford care if they get sick. For the many who were previously eligible for fully or partially free care, the new coverage means worse financial problems and, in many cases, less access to care.
4- The American public who are once again being taken down a health reform blind alley. Costs are still rising, insurance plans are getting skimpier and politicians use Chapter 58 to avoid discussing the only real solution – national health insurance .
David Himmelstein is an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program
To me, this is a poor post that is merely an advertisement for the author’s organization. At the end of an otherwise good analysis, Prof. Himmelstein casually dismisses the whole topic and calls national health insurance the “only real solution”. Rather than explaining why he believes that, he merely links to the front page of an organization that lobbies for it.
I haven’t seen any other contributor to this great blog do that, including those who share Himmelstein’s opinions. Whenever a writer links to another web page, it is a link to a specific report or paper that supports what the writer is saying, and usually it links to a third-party’s site.
The blog entry spreads dangerous misinformation.
First, legal immigrants, even legal immigrants ineligible for MassHealth, are eligible for Commonwealth Care. This was one of the unnoticed victories of health reform. The 3-year fight with the Romney administration – which cut state-funded coverage for low-income adult legal immigrants who don’t qualify for MassHealth — was settled when chapter 58 gave legal immigrants full Commonwealth Care eligibility.
Legal immigrant children, by the way, never lost coverage; they’re ineligible for Commonwealth Care because they’ve always been eligible for MassHealth; undocumented kids can get CMSP which covers primary care and is free for those below 200% of fpl, and sliding scale above that. So kids are not losers in any way. They gained – the law expanded MassHealth from 200% to 300% of poverty.
Second, to write about “the end of the Free Care Pool” is simply false. For undocumented immigrants, the Pool is not going away. Health reform budget projections assume continued Pool eligibility for undocumented immigrants and others with no other source of coverage. The Pool will also continue to cover copayments and deductibles for low-income underinsured.
State policymakers and the public will have a debate this summer over whether or not the Pool should restrict coverage for people who are eligible for Commonwealth Care or employer coverage, and the coverage is affordable to them, but they turn it down.
But we do not see any responsible policymaker advocating positions that would put safety net institutions in deep trouble, as the post suggests.
One other error: “the phase-out of hospital contributions to the Pool” is not in chapter 58, and was not contemplated by anybody.
People can responsibly disagree about the health reform statute, but the debate must be grounded in the facts.
You can see further down on this site where other people–other professionals–have also included URLs to the sites of viable alternative movements in the health care debate with which they agree (and have even worked to grow). They’re all white papers–this is an opinions page. He includes the URL of Physicians for a National Health Program in that same spirit of public citizenry; whether he co-founded it is beside the point.