I have enjoyed reading this forum for the past several months as there has been interesting, provocative and intelligent commentary on the early implementation of health care reform.
Let’s face it, though—most of the contributors and the readers are actively engaged in the political process, delivery of health care and/or health care coverage, and know full well that the Dec. 31 deadline for coverage is looming. But as John McDonough, executive director for Health Care for All, has recently pointed out in this forum, there is a tremendous need for education aimed at the working person who is barely aware of his or her responsibilities under health care reform. Moreover, there is even less awareness of the penalties that go into effect on January 1, for those who do not sign up for health insurance. November and December provide us with a unique teachable moment. We all—the Connector, providers, health plans, advocates and communities—must join with the media to raise people’s consciousness.
The Department of Revenue intends to highlight the issue when tax forms go out in January. That’s too late for people to avoid the penalty. In fact, enrollment by November 15 for a December 1 effective date is necessary to avoid the penalty. The legislature should permit enrollment effective January 1, to satisfy the mandate.
I firmly believe that most people would choose to purchase health insurance if they knew they had the opportunity—especially if they knew there were financial consequences if they did not.
In addition, as I have talked to many over the past months, I’ve discovered that there are a number of people who have access to insurance through their employers, but haven’t availed themselves of the coverage. These employees could enroll in non-group plans directly through insurers or through the Connector. However, many would receive better benefits and/or pay less toward premiums by enrolling in their employer’s plans, and they should be encouraged to do so with coverage effective by December 31.
What do we do?
First, we must use the time we have to engage in a dedicated effort of public education. I know the Connector intends to continue its broad-based public awareness campaign during the next months and I applaud its efforts. Tufts Health Plan has partnered with other not-for-profit health plans and the provider community to raise awareness through the Massachusetts Health Care Reform Coalition, and its efforts are ongoing. I also encourage the Department of Revenue to begin its public education campaign in this year, when it can still make a difference.
Second, we need to give people additional opportunities to obtain health insurance. Therefore, I propose that the Division of Insurance consider a special open enrollment in all plans to offer one more opportunity—when people are paying attention—to meet the needs of those who were unaware of the mandate. In fact, Gov. Patrick should also request employers of self-insured plans to make the opportunity available to their employees as well.
As we implement health care reform we will continue to encounter unexpected barriers. To make it work, we must be flexible and go the extra mile to ensure that our citizens have affordable health care and that they understand the consequences if they do not.
James Roosevelt, Jr. is the President and CEO of Tufts Health Plan.
This is a response from the trenches, and I think it is representative of what we are all finding out in the marketplace of health care reform in Massachusetts. The education of the employer-based market has been going on for several months. If people are not signing up, it is not due to lack of knowledge or opportunity. It is because we have not yet begun to address the issue of making health care more affordable.
I, like many of my colleagues who are emloyee benefits brokers and consultants in Massachusetts, have availed myself to employer health insurance clients and their employees to help get the uninsured enrolled – whether it is in the group plan through special open enrollments (which, by the way, all the carriers held for July 1 of this year and which at least one carrier has extended through the end of this year), through inviting representatives in from Commonwealth Care providers and Insurance Partnership programs to help employees apply for subsidies if eligible,through setting up S125 plans and conducting meetings for part-time employees, etc.
Jim, as your broker advisory group what their experiences are. I think it will bear out that the employee benefits brokers in this state have been beating the drum, pounding the pavement, and going above and beyond the scope of their services for no other reason than to help make this reform plan work. But at the end of the day, people are going to make a value decision – Can they afford to have insurance? Can they afford to not have insurance?
Increased deductibles and copays make insurance less expensive, it is true. And some good options have come out of health care reform to that end. I think we also have to tackle a very difficult topic and that is what we require to be included in the insurance policies to meet the definition of adequate coverage, or minimum creditable coverage. The state has not up till now had an appetite for limited mandate plans (although they have allowed some exceptions in the under 26 market), and the MCC requirements I believe are too high to offer people choice and flexibility in buying insurance.
Lastly, we have not yet begun to address the cost of health care and how to rein it in, as one carrier expressed, at least to be in line with the standard inflation rate. I look forward to the work of the Cost and Quality Council to help us along the way.
Thank you for allowing me to put in my two cents. We all have similar goals, but I do not feel that the DOI or governor, the DUA or the Connector, can change the results with your proposed open enrollment extension or more advertising dollars funded by the state. It will take more forward thinking to tackle the uninsured numbers before insurance rates go up to the point that the number of uninsured starts growing.
In response to James Roosevelt Jr.,
My wish is that when the public as you say are “educated” and realize the rip off insurance plans and the penalty DOR has instore for them will create an uproar and revolt. We the people are fed up and people like yourself and others feel it is necessary to come to this blog to insult and threaten the citizens in my opinion it will backfire.In your profession being what it is don’t you think your somewhat bias?
Mr. Roosevelt,
Ms. Jennings is quite correct, the problem here is not education. The problem is that most of us have examined these policies and decided that they are not worth the investment. As AnnS has eloquently pointed out elsewhere on these pages, these plans fail the affordability test miserably! Furthermore, unless one purchases the Gold Plans, these products don’t deliver much in the way of care. What people want is access to physicians and hospitals when they need them, not worthless insurance products. Frankly, if these things were worth a damn it wouldn’t be necessary to bludgeon us into buying them.
Mr. Roosevelt, How about you cut your company’s bloated workforce by 50% and then you can talk about what other people should do. And how much do you make per year? How about the rest of your management team? If you expect me to cut to my bone, then I expect you to cut to yours.
It amazes me how many people don’t have a clue what this bipartisan bill has instore for the citizens of Massachusetts. Apparently our legislators don’t quite understand why so many people are uninsured. Quite simply they can’t afford it. I personally dropped my health insureance five years ago when my 3% yearly raise could not cover the 20% yeasrly increase of my health insurance plan. There is so much corruption in the health care system. You pay through the nose for insurance and you get 10 munutes with your doctor. Just long enough for him to decide what pharmaceutical drug best fits your symtoms. Our elderly are being over medicated. In fact there whole social life revolves around what specialists they are going to see. This Generation of children are the sickest I have ever seen. They are also the most vaccinated, and lets not forget the over prescribing of psychiatric drugs. Lets face it. Medicine has now become a religion. So now the answer is to force every citizen to buy health insurance, with absolutely no cost control. Its my personal opinion that the only health insurance I have is to stay away from drug pushing doctors. Our health care system is an abomination. This is just another way to force the middle class into bankcuptcy. Government has no business practicing medicine, or mandating citizens to buy into private insurance companys whose only responsibility is to increase its profits. Wake up America! I have made a vow to vote every single one of these career criminals out of office.
[...] January 1st instead. Will the penalty apply to these people? On Commonhealth, WBRUR’s blog, James Roosevelt of Tufts Health Plan writes about moving the deadline from New Year’s day to New Years Eve so people who enroll in December [...]