On April 17, the Senate unanimously approved a comprehensive cost containment bill designed to rein in the state’s spiraling health care costs.
The vote could not have come at a more crucial time for the Commonwealth, as several converging factors are threatening to undermine the state’s efforts to ensure that all Massachusetts residents have access to health insurance.
Consider the following:
• In the last two years, approximately 340,000 Massachusetts residents have secured health care coverage, a milestone state officials did not expect to reach until Year 5. Over 176,000 have signed up for Commonwealth Care, the state-subsidized program for low and moderate-income residents. Nearly 75 percent of these individuals make no monthly premium payments, so the state must pick up the costs.
• The state originally projected the cost of providing subsidized health insurance in Fiscal Year 2008 would be $618 million. Governor Patrick is now asking the Legislature to pass a supplemental budget to cover an estimated $153.1 million shortfall in the Commonwealth Care program.
• When the health care reform law went into effect in 2006, it was expected the state would be paying $750 million to support Commonwealth Care in Fiscal Year 2009. But when the Governor released his budget in January, he allocated $869 million for these costs. Now, the Administration is saying the true cost for next year will be “significantly” higher, topping $1 billion.
• The federal waiver the Commonwealth has been operating under for the past three years is due to expire this year. This waiver has provided Massachusetts with $385 million annually to help pay for its health care costs. If the waiver is not extended, the state will have to come up with that money instead.
Is it any wonder some people are starting to refer to health care reform as the next Big Dig?
So far, all the cost estimates surrounding health care reform have been way off. I’m beginning to wonder if anyone really knows what the ultimate price tag will be, but unless we get these costs under control, the law could end up bankrupting the state.
Negotiations between the state and federal government have been ongoing since December. Senator Richard Moore, who is participating in these discussions, says he is “cautiously optimistic” the waiver will be renewed, but the state will not know the final decision until sometime after the House and Senate budget debates have ended.
All of this is taking place against the backdrop of a national recession, which will further limit the state’s ability to cover unexpected cost increases.
The state has had great success in signing people up for health insurance coverage. However, the real measure of the success of Massachusetts’ health care experiment will be determined by how well we can control costs.
Senator Richard R. Tisei
Senate Minority Leader
CommonwealthCare needs to add an asset test in addition to the income test for eligibility. It makes no sense that someone, who may be asset rich be eligible for subsidized health insurance based soley on income.
Take an example of two people living in the same neighborhood of equal assets. One, however, may be self-employed cash business and qualify for CommonwealthCare but the other would not since he is a w-2 employee.
Bill,
Are you saying that someone who owns a home and has very modest retirement savings should be forced to sell their home and spend the savings they will need to supplement their low social security check in old age?
What MA is doing to low-to-middle income, hard-working taxpayers is bad enough as it stands now.
You are one scary person! Get a life!
Mr. Tisei,
“All of this is taking place against the backdrop of a national recession, which will further limit the state’s ability to cover unexpected cost increases.”
Sounds to me like all you care about is the state. I thought you took an oath to represent and care about the people.
There are hundreds of thousands of hard-working residents who couldn’t afford the premiums and copays that the Connector decided were affordable based on the 2007 costs, so now they have lost their personal exemption. $219 for an individual and $438 for a couple happens to be a large chunk of change necessary to pay necessities in this day and age.
The costs for the lowest income residents – 300% FPL and below – will increase 10% for premiums and 100% for copays on July 1 while the cost of living skyrockets weekly. Incomes do not go up weekly or monthly and in some cases not even annually.
Aren’t you concerned about residents who won’t be able to pay for their food, heat, gas to get to work, property taxes, etc.? Even without the insurance or penalties for 2007 and 2008, most are already hard-pressed to make ends meet.
Big Dig II was the name we gave this nightmare many months ago. In fact, this was mentioned on our local access TV station during a broadcast about this nightmare.
A better name for it is The Boston Strangler.
Bill Randell is an INSURANCE BROKER and he thinks taking residents homes is a good idea.Senator Richard Tisei thinks that chapter 58 is a good law.This is a brainwashing from the insurance companies and the state house.We the people have to throw the bums out!The Sentors,Representatives,Insurance lobbyist.None of them care about the people,they have already ruined our Country from State to Federal governments are working for CORPORATIONS and our Country is paying the price.Plesae vote all out of office before it’s too late.
Yes, I am an insurance broker? My point was that a person can literally be worth millions of dollars and can qualify for CommonwealthCare since income is the only qualifying question. Besides income, there needs to be an asset test in order to qualify for CommonwealthCare.
Yes, cost control is essential and it can–and must–go hand in hand with guaranteed access (comprehensive coverage) and improved quality.
The only equitable and affordable solution to achieve cost control, guaranteed coverage and quality oversight is to create a program of social insurance. This is also called improved Medicare-for-all or single-payer health care. Watch the recent Frontline program “Sickness around the world” to see how this is done very effectively in 5 other capitalist democracies. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries
Clearly, a streamlined social insurance plan is the optimal way to spend monies collected for healthcare the most wisely, if financial stewardship is a goal.
Responsible financial stewardship of healthcare dollars is not happening if the current and very large amounts of money continue to be spent paying brokers like Mr. Randell and the Commonwealth Connector sub-Connectors and their sub-Connectors (it’s no joke–this level of wasteful bureaucracy really exists!).
Responsible financial stewardship of healthcare dollars is not happening if we continue to spend over 30% of every dollar on administration and market-driven bureaucracy. It is not happening if we continue to pay the multi-million dollar salaries to the state’s non-profit insurance co. CEO’s like Cleve Killingsworth, James Roosevelt, and Charlie Baker, not to mention their minions of highly paid executives like Andrew Dreyfus and Bruce Bullen.
One can reasonably expect that if you asked taxpayers and most business owners and investors if they would prefer better financial stewardship the answer would be yes. The logical next step is to ask elected officials at all levels of government to step up to the plate and work with the growing number of citizen-activists who support social insurance health reform.
It would do a lot to restore people’s faith in government if a public commitment was made by politicians and public agency leaders to put patients before profits in health reform and enact social insurance on the state level with SB 703 (see http://www.masscare.org ) and ultimately on the federal level with HR 676 (see http://www.healthcare-now )
Norma, I do not think “taking residents houses is a good idea”. I do think allowing someone to qualify for CommonwealthCare is a bad idea based soley on income.
Bill,
The State of Massachusetts has made being “uninsured”a crime,one which insurance companies benefit from.The fact is middle income cannot afford the insurance so what does the state do?Fine residents,Blue Cross in fact wanted the mandate,I wonder why?The Country is going broke from greed.Greed from housing market,greed from oil industry,greed from health care insurance,on and on.Health insurance is another mortgage payment for some and that is going to break the backs of the middle class.The wealthy get care,the poor get care,Where does that leave the middle income?What about the Right to Privacy?I assume you have insurance,Did you show all your financial records to get it?Would you like to?I want my right to privacy don’t you?
We all need to get behind the system called for in Ann Malone’s excellent post. We all need to join as one in an organized effort to:
1. Inform each of our representatives that the MA. mandate is absolutely unacceptable-as it is NOT healthcare reform. Ask how they could support a status quo mandate which foolishly funnels over 30% of OUR healthcare dollars into the pockets of insurance companies when ready, working, alternatives exist around the world?
2. Insist that a temporary moratorium is placed on it’s continued “rollup” of taxpayers into its web.
3. Request your rep. view http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries
4. Request your rep. support SB 703 (see http://www.masscare.org)
Individuals are being fined and criminalized by the state as “soft targets” for not signing onto their mandate. We are targets because we are not organized. Business owners are not targeted because they are organized but all of us-individuals and business owners-need to act as one in support of http://www.masscare.org and SB 703
Norma:
I agree that a person’s right to privacy is very important and “no” I did not show (and should not have to show) my financial when I obtain my private health insurance, which I pay for. On the other hand, if I wanted to apply for a subsidized sponsored that the tax-payers pay for (you and me), it is only right that my financial information has to be reviewed to qualify.
My point is that review income is not enough. An asset test must also be added since a person of substantial assets can qualify for CommonwealthCare. This is the exact “greed” that you refer to and it needs to be stopped.
Bill,
The greed I refer to is CEO’s making millions of dollars.You do not agree that is not greedy?Also,it is not my fault to be middle income and lost my health insurance when my husband retired.We do not quilify for Commonwealth Care.But if I did it is not right to have to be forced to give the state any property I might own.To me that is not a democracy when citizens are forced to give up their homes.That is a dictator state and that does not scare you?
Norma:
Who said that you have to give up your home to qualify for CommonwealthCare?? I have no idea why you keep saying that.
Health insurance is very important. I know many people, who keep working only to keep the health insurance. Maybe your husband should not have retired?? Even then weren’t you eligible for COBRA?
Evidently your income put you above the qualifying limits. You can still options, go to the Connector or maybe you or your husband should look for a job with benefits?? It is not that you do not have choices, you just want it for free…
None of this has anything to do with my original point that CommonwealthCare needs to add an asset test,in addition to income test, to be eligible for benefits.
This a dictator state, are you serious??
Bill
Let me reply to several of you individually:
Bill,
You make some valid points, there are a hundred ways to scam this system, and I’m afraid that our legislature failed to consider any of them.
Ann,
Thank you for continuing to point out that we truly could provide care to everyone, at a substanial savings, if we could get past our archaic notions of what a healthcare system ought to be, and our “leaders” started working for their constituents rather than the monied special interests who called the shots on Chapter 58.
Scott,
You are absolutely right, unity is the key to attaining the goal. We must work at the grassroots level to organize, educate and mobilize those who believe that access to decent and affordable medical care is a basic hyman right in a civilized society. Will the desperate have to start demanding care at the point of a gun to get our politicians to see this?
Reporter,
The growing recession may very well doom this beast. The sooner, the better from my perspective.
Norma,
There is no question that you and hundreds of thousands of others in this state have been wronged. Make your outrage known at the ballot box; I will.
This system just amazes me. I work for an ASAP. There is a new choices program to keep the elderly out of nursing homes which should save a lot of money, they have to be nursing hoem eligible and fall within the 300% of the poverty level. Of course they put the fox’s incharge of the chickens. There are people on these programs that are being qualified for these waivers, getting Mass Health and driving around in cars. The nurses qualifying these elders of course are justifying their pay checks all in the name of doing good. This is how disgustingly corrupt this whole Welfare State is. I struggle to put food on the table, heat my house, pay my rent, and I cannot even afford health insurance, but I can dam well pay for everyone else to have subsidized rent, fuel assistance, food stamps and health insurance. I’m with you Norma. From now on I’m voting every career politian out of office. Its time Americans woke up out of their fog and to begin a peaceful revolution before we wake up in the morning and find ourselves living in a facist Country. It sure is headed that way.
The entire state of affairs is sad, that’s for sure. I’m self employed, my wife is self employed, partly retired (she’s 61). We pay 20% of our income for this. Sure, it’s insurance companies. But it’s also our antiquated idea that “employers” should pay, when that hurts the self employed the most. But it’s also our “fee for service” method of paying doctors, hospitals, labs, etc. that is the true crux of the matter. That wastes huge money and actually hurts patients with unnecessary tests and procedures. And, yes, it’s kept in place by even more greed. You think the guys at the top of Blue Cross make a lot of $$? Try the ones at the top of Lilly and Merck, etc. What’s sad is the number of people walking around who still believe in literally hundreds of myths about why it’s so expensive. It is these members of the public who allow all this to continue and will carry us directly into the train wreck that is coming. It’s sad because I don’t know how to create a major cultural shift in attitudes toward medical care delivery and the dismemberment of the Medical Industrial Complex that’s driving this thing. Sad because right now, it looks like a true train wreck is the only way this is going to change. Bill, please, start looking for a new job right away. We don’t need you to do the one you have anymore.
Glenn,
Its rotten from the top on down. Our elected officials do not work for the people anymore, they work for the special interests with a whole lot of $$$. The main players are the military, medical, and petro industry. The problem in this country is not that we don’t have enough health care, we have too much. You pay through the nose for a ten minute MD visit and walk out with a prescription. The Pharmaceuticals are writing the standards of care. The doctors go along with it because they don’t dare not to. They supress safer alternative medical treatments, and the ones they do allow Insurance won’t pay for. I’m even affraid that we no longer have the power of the vote anymore, since it appears they have that rigged as well. The good thing is the masses are slowly waking up. Lets hope its not to late.
Bill,
If Commonwealth Care affordability is based on assets and, thus, a resident is eligible for a higher premium (and copay) or is pushed into Commonwealth Choice, how would he/she pay?
The only way they could do so is to sell their property or cash in their retirement fund. Otherwise, they would be required to pay with income they don’t have.
Do you have any other brainy ideas you’d like to share?
That said, whether Commonwealth Care is based on earned income or assets, this is all a diversion from the problem at hand which is: we need affordable, equitable, quality health CARE, not a mandate to purchase inferior, expensive insurance that doesn’t save us from medical debt or provide us with appropriate care if it cuts into insurance companies’ profits.
You are not part of the solution and really will need to get another job because very soon we will be telling the presidential hopefuls what WE want; that what THEY want is not acceptable to us.
btw, there was a Truth Hearing in Boston this morning attended by health care advocates from other states who learned firsthand about this harmful MA mandated health insurance law and how it is failing. These folks went home with folders chock full of relevant articles, grassroots testimonies and information about this law that has not been disclosed to the public.
Due to this event, they have been educated and are in a better position to inform others and stop, in each of their states, what was sprung on us without our consent. They can now spread the truth about what is really going on in MA instead of the success spin that is being perpetuated by the media.
Peggy and Glenn,
This country is already ruled by the corporations and medical industrial complex via our do-nothing legislature. In America, the people are afraid of the government; in Europe, the government is afraid of the people.
People are slowly catching on but I pray it isn’t already too late. The next election could be fixed with the advent of today’s Supreme Court ruling that a driver’s license is needed to vote. For those who don’t have one, an affadavit (or something similar) can be obtained 10 days in advance. (I heard this on NPR tonight while I was doing something else so I may not have it quite right.)
This targets the elderly and the poor who are most likely to vote for a democrat (not that democrats are doing anything good for the people). Nuff said?
But we still must keep hope in our hearts and continue to fight for change.
I must respond to Bill Randell’s insulting post.
I suggest he download a copy of the MassHealth Application which a resident must fill out in order to comply to the chapter 58 law.
The first page states that when I sign this application the state may recover my assets.
Cobra is at least $1000.00 a month.
My husband was forced to retire because has health issues from 50 years of hard labor.
A person should not have to rely on employment to get health care.Anyone can lose a job.
Not everyone has a cushy office job,my husband is a lifelong resident of this State and has always paid his taxes.We don’t want anything for “free.”
Norma:
Insulting?
The first page of the application states that if I lie to qualify, then the state has the right to recover assets from the applicant who lied. I have no problem with that.
Sorry to hear that you husband was forced to retire, however, I do not think a person should rely on the government for their health insurance if they have adequate assets to pay on their own.
My health insurance at my “cushy” job cost approximately $900 per month. If you are not willing to pay $1,000 per month, but are willing to pay something (you do not want it for free)–how much are you willing to pay?
Lastly have you ever totaled up how much in benefits that your husband and you incur in benefits each year? I bet you that it is more then a $1,000 per month.
Bill Randell
Norma:
Sorry I have to ask. If you husband worked 50 years, I woud assume that he is at least age 65. Aren’t you eligible for Medicare?
Bill
Ann:
The Connector will not utilize the “Estate Recovery Program” for CommonwealthCare members. Although the wording on the application does not make that clearand should be changed.
At the same time if someone has a million dollars in assets and a home with lots of equity in their home,for example, should they qualify for free health care solely based solely on their income.
My whole point on this blog was that the enrollment and free care, which the Commonwealth can not afford, has been much higher then expected because eligibility was based solely on stated income. In order to ensure the viabiity and survival of Commonwealthcare an asset eligibility test must be added.
Ann – your comments are interesting, but the name calling is not cool.
Martha
Martha:
Thank you. I am new to this blog and am an insurance broker representing all the major HMO’s helping my clients understand all their options, Section 125/HRA/HSA/FSA and the implications of the new Commonwealth Health Reform Law.
A friend of mine referred this site and I have been reading with much interest the past week and have been putting on some comments, which I think have some credence. What has blown me away is how much some of the posters think the insurance industry and brokers like me are evil people?
Other then that, I have found the blog to be quite informative. Keep up the good work.
Thanks
Bill
Martha – What “name calling” would that be? It seems that you censored my comment so I do not know what you are referring to. I truly cannot recall, what horrid “name calling” did I commit?
Please send my comment to me for clarification, and so I and others will know the wbur Commonhealth Blog censorship guidelines. My email is ann@defendhealth.org
One person’s “name calling” is another’s “giving credit where credit’s due”. Or another way of putting it is that naming names is having actual human beings take ownership of their behavior.
Oh, I’m starting to recall the comment now. You don’t mean name calling as in naming names, you mean as in using terms that are judgemental in describing certain behaviors seen as harmful to others. It appears that degree of honest expression is not allowed on this blog. Good grief. What are your priorities?
Martha: P.S. Our current healthcare system has maimed and killed hundreds of thousands of people in order to maintain market-based and profit-driven healthcare. This is “not cool” either.
What responsibility do HMO’s and their broker-operatives such as Bill Randell, and the HMO board of directors such as newly elected Congresswoman Niki Tsongas (Fallon HMO), shoulder for these preventable injuries and deaths?
Bill Randell:
“The Connector will not utilize the estate recovery program for Commonwealth Care members. Although the wording on the application does not make that clear and should be changed.”
A contract must contain full disclosure and this one does not. If the Connector or state have no intentions of taking assets from Commonwealth Care members now or in the future, specific langauge excluding Commonwealth Care should be printed on the contract.
The Connector is fully aware that this is a problem. They have changed the contract twice – in Nov. 07 and again in Jan. 08 but have yet to add this language. In fact, they should have taken care of this when they created this program. They have received requests to do so at public testimony and in writing as well as a letter from one of our reps. They respond to nothing and no one. Curious, isn’t it? They are willing to tell people the estate recovery program doesn’t apply to Commonwealth Care but they won’t put their money where there mouth is. Perhaps they wish to keep this option open. It’s a great way to pay for a failing policy.
I wouldn’t sign that form in a million years the way it is and neither will thousands of others in this state. Attorneys have reviewed it and advised the same.
Maybe, at this point, they don’t want to change it because they don’t want any more people in Commonwealth Care – it’s costing the state too much. They are probably happier receiving penalty money to meet budget neutrality. But taking estates is really a better deal for them.
Did it occur to you that the reason they doubled the copays for the 300% and below FPL people was to discourage use of the insurance to save the state money?
They also dropped Plan 4 because it attracted the sickest residents and was costing the state too much. This plan had a slightly higher premium than Plan 3 but copays were half the cost. Oh well, the heck with the sick people who benefitted from that plan.
You really don’t get what this law is about, do you?
Please stop acting like you know it all. Quite frankly, from where I sit, you have no clue how this law is seriously hurting people – financially and with regard to the Connector dumping people, not paying medical bills, etc. In fact, I just read a report that they were sued for not paying a patient’s bills, and I personally know another resident who has the same problem and will be going after them as well.
By the way, you haven’t responded to my question above: If Commonwealth Care affordability is based on assets and, thus, a resident is eligible for a higher premium (and copay) or is pushed into Commonwealth Choice, how would he/she pay?
Should they sell their property or cash in their retirement fund? Otherwise, they would be required to pay with income they don’t have.
First of all, I agreed with you that the wording needs to fixed.
Secondly, I do not believe people who have a certain net worth should qualify for CommonwealthCare.
Thirdly, if CommonwealthCare affordability included an asset and someone had to tap into the equity of their home or retirement fund, I have no problem with that.
Reporter, let me ask you this. Take an example of someone who has owns their house free and clear worth $500,000 and another $500,000 in retirement funds but qualifies for free health insurance under CommonwealthCare for their health insurance based on their income. Do you think that is fair?
Bill
Under your plan a person could literally own a house with a million dollars in equity and have another million in
Martha,
I feel so strongly against chapter 58 health care law,it is morally and ethically wrong.Most residents cannot afford the insurance and the State and the Commonwealth Connector insist we buy in anyway.The Governor won’t listen,the legislators won’t listen,where does that leave us?This blog has helped us get out the truth of the matter.For the most part all the contributors are for the law.This is a biased blog for chapter 58.
Bill,
yes my husband is on medicare but I am not.I think the industry you work for is ruining our country and nothing will change my mind.Too many are going broke trying to pay for insurance.
Norma:
You were eligible for COBRA from your husband’s past employer. Since your husband was eligible for COBRA, you could have been on as a single employee. This should have been alot less then the 1,000 you mentioned since that was most likely a family plan.
Typically COBRA is good for 18 months but if it is the result of a disability I believe you would have been eligible to remain on your husband’s old company as a single for 36 months.
That would have been the way to go and I hope that is what you did.
Bill
Dear Readers – Let’s not allow ourselves to be distracted by Bill Randell’s self-interested insurance broker-driven comments and that line of thinking. These are merely a distraction from the core issues before us. Norma gives voice to these issues very clearly, as do many other commentors here.
Is BRs example of a person with a net worth of $1Million applying for CCare realistic and so even worth our time thinking about? A person with anywhere near that amount of wealth would have health insurance already!! BRs paternalistic advice to Norma is insulting and offensive; she knows about Cobra and knows if she can or cannot afford the insurance products available to her. BRs line of thinking is the same as Ronald Regan’s “Wefare Queen” attacks against the poor.
Healthcare and health insurance must be treated as a public good and not as a market-based profit-driven commodity. Period. This is one of the most urgent moral issues confronting us: the need to enact social insurance on the state level with SB 703 (see http://www.masscare.org ) and ultimately on the federal level with HR 676 (see http://www.healthcare-now )
Ann:
I did not mean to offend Norma. I was just trying to point out some of the benefits of COBRA, that alot of people are not aware of. If I did offend Norma, I do sincerely apologize.
As far as my example goes, I think it is realistic. Cut it half, if you want, say $500,000. Botton line is that a person with a net worth of 500K, a million or ten million can qualify for CommonwealthCare if their stated income falls into the guidelines. This does not make sense to me.
That has been my point throughout this discussion.
BR
BR:
Your points are distractions from the real issue at hand.
Ann
Ann:
An estimated $153.1 million shortfall in the Commonwealth Care program is not a distraction but most definately a real issue that needs to be dealt with.
BR
Hi Norma – I hope you are well. I would love your “guest contributor” suggestions.
Best, Martha