Earlier this week, The New York Times published an article that rightly laid out the challenges of government mandating insurance coverage to its citizens. I agree with the comments made by Diane Rowland, executive vice president of the Henry J. Kaiser Family Foundation, a non-partisan organization that focuses on health care policy analysis and large-scale public heath information. She said “that an individual mandate is the only alternative to government provision of coverage if you hope to achieve universal coverage.”
Universal coverage has been the goal of Massachusetts’ health care reform efforts from the very beginning. Our experience is reflective of a profound social revolution with the fits and starts of any worthwhile, ambitious undertaking. Right now, we in Massachusetts are at the first real critical juncture of the implementation of health care reform: having our citizens enrolled by year’s end, before they suffer a financial penalty. The good news is that Commonwealth Health Insurance Connector Authority claims that enrollment is exceeding expectations. Health plans such as Tufts Health Plan want to make it as easy as possible for people to enroll, and as a result, Tufts Health Plan is suspending usual operational requirements so that any individual who enrolls with us through our individual channel by Dec. 31 will be covered and thus, able to avoid the 2007 penalty.
The bad news is that for many, health insurance continues to be a “grudge purchase,” with people hedging their bets that illness won’t strike or accidents won’t happen. The challenge lies in ongoing education of the public. Many are simply unaware of their responsibilities going forward, and the costs that they will incur if they choose to ignore the mandate.
To date, the focus has been on the $219 penalty that will be incurred at tax time if people do not enroll in health care reform products by Dec. 31, 2007. What is less well known and needs to be brought to the attention of the public is that in addition to the 2007 penalty of $219, there is a monthly penalty for remaining uninsured, which is based on half the cost of the lowest premium in the market. This could translate to $100 to $150 for each month that an individual is uninsured. In other words, if someone waits until June 2008 to purchase insurance with a July 1 effective date, they will accumulate roughly six months worth of penalties. That’s a total cost of between $600 and $900—and that person would still be uninsured. There has not been enough public discussion about the cumulative effect of these penalties.
As the year draws to a close, we can’t limit ourselves to thinking about December 31, 2007 enrollment. Instead, we need to be engaged in a large-scale public education effort on what it means to remain uninsured in 2008 and move people towards the goal of universal coverage.
James Roosevelt, Jr., president and CEO, Tufts Health Plan
Absolutely correct. This is all part of the process of implementing a new social mandate (change is never easy). As I stated in my previous entry these mandates include auto insurance, the minimum wage, and personal income tax, which is a mandate, although we don’think of it as such. We in Berkshire County have started a television and print media campaign to make the public aware of the guidelines of the 2008 penalty structure and the availability of new opportunities, including Commonwealth Care. Significantly, a number of individuals have shared with us, they would have never known about Commonwealth Care if they weren’t motivated by the mandate.
Very interesting discussion, but one that leaves lingering questions.
To C J-H, Re: “We in Berkshire County have started a television and print media campaign to make the public aware of the guidelines of the 2008 penalty structure…”
In the interest of ethical conduct involving disclosure and transparency, could you be so kind as to let the readers here know where the funding for your media campaign is coming from? Is it state taxpayer money via a state grant r/t the legal mandate? Is is money from Blue Cross Blue Shield that they have been distributing to community groups to conduct activities in support of the mandate law to purchase a private insurance profit (that BCBS sells the most of)? Is it from both and more? Thank you in advance for responding.
A question for J R from Tufts HMO: Could you say a few words about “government provision of coverage” that was in the quote you led off with from the VP of Kaiser Foundation (“that an individual mandate is the only alternative to government provision of coverage if you hope to achieve universal coverage.”). Your thoughts on this as a HMO Executive will be enlightening. Thank you in advance for responding to this sincere inquiry.
One could wonder if the point made by Ms. Rowland from Kaiser is part of the reason that all three of the leading Democratic presidential candidates include a public/government insurance plan purchase option in their health reform proposals.
A lot of citizens here in MA wonder why the MA plan only includes purchase of private insurance products under threats of stiff penalties, as Mr R and Mr J-C above are quick to point out. Could this (disturbing) fact have something to do with the record-setting >$7.5Mil* that was spent on lobbying to influence the MA health insurance mandate law. It sure would be interesting to know how much of that $7.5Mil came from MA HMO’s. Something doesn’t doesn’t smell right here.
*source: LOBBYISTS TOOK IN $7.5M ON HEALTH BILL
By Scott Helman, The Boston Globe, April 5, 2006)
OK, but this will be my last response. Indeed, among others, we are proud recipients of grants from EOHHS and the Blue Cross Blue Shield Foundation of Massachusetts. And, for what it’s worth, our referrals are to help low to middle income uninsured residents enroll in MassHealth and Commonwealth Care, which Blue Cross Blue Shield does not participate in.
“The bad news is that for many, health insurance continues to be a “grudge purchase,” with people hedging their bets that illness won’t strike or accidents won’t happen.”
Do you people NOT GET IT or is this just another spin-twist? It is not at “grudge purchase”. People just can not afford it – period – end of story. To use a blunt old saying, “It’s the economy, stupid!”.
The fact is that this law was sold to the legislature and the press using false numbers – false population counts, false coverage promises, false costs to the State (taxpayers),false language, “universal health care” vs. “for profit commercial insurance” and false premium costs.
Please be honest and stop the spin.
In response to Chip Joffe-Halpern,
who by the way is President of the board of Directors for “Health care for all”! Isn’t your job to answer these and any questions? Don’t you collect a large salary?I am middle income and uninsured and so far nothing your organizations has done has helped me except buy into bogus and exspensive insurance plans.Or do you post on this blog just to threaten us?
Look, Mr. Roosevelt, we get the concept. If we do not bow to your will and purchase insurance the state is going to hurt us. I believe the appropriate term for that is extortion. The problem is, we couldn’t afford your dubious products last year, we still can’t afford them this year, and with a 10-12% premium increase looming, we certainly will not be able to afford them next year! Fortunately, the government is not the only body capable of imposing economic sanctions. Let us share the pain. I recommend that people curtail their holiday spending by an amount at least equal to the tax penalty which will be imposed. Sorry retailers. Boycott the state lottery. Sorry cities and towns. Purchase most of your holiday gifts on line. Sorry DOR. Furthermore, I call on all who will be injured by this law to boycott road races,concerts, tree lightings and other miscellaneous events sponsored in whole or in part by health insurers. Or better yet, use these events as an opportunity to protest the penalties.
Mr. Joffe-Halpern, the constitutional authority of the state to compel the purchase of products from private enterprise is doubtful, and unlikely to withstand an honest judicial challenge. The analogy comparing mandatory auto insurance to compulsory health insurance is incredibly weak. Operating a motor vehicle is a privilege. One may choose to forgo driving and pay no penalty. Not so with Chapter 58 and health insurance, if one is forced to remain in Massachusetts, the mandate constitutes a tax on life. Legitimate taxes are levied to support the common good; if health care were financed by a fair and equitable tax I would support such a mandate. I cannot, and will not support a mandate that serves only corporations!
Well said Ron.
Chip Joffe-Halpern
You write “for what it’s worth, our referrals are to help low to middle income uninsured residents enroll in MassHealth and Commonwealth Care”
Low income-yes.
Middle income? Nope.
Average household is 2.54 people.
Median household income (50% have more and 50% have less) is $59,963.
$59,963 for 2.54 people is 385% Federal poverty level.
The ‘middle income’ households are not eligble for MassHealth or Commonwealth Care. And they are exempt from purchasing Commonwealth CHoice because their incomes are too low.
A household of 2.54 people would have to have less than $46,707 a year to qualify for Com Care.
The 40th percentile through the 60th percentile of incomes are the economic middle class in MA.
That is incomes from $47,360 to $74,195.
THAT is the ‘middle income’ group and the statistical probability of any of them being eligible even for Com Care is extremely low unless they have from 2.6 people in the household (low end and that means premiums of $2520 a year just for the 2 adults) to 5.17 people in the household (high end) Odds are less than 50/50 that they have 2.6 people in the household and forget the odds of having 5.17 – and then you factor in the income limits.
Don’t pretend that Com Care is thisgreat thing for the economic middle class. It isn’t. They have a far far greater chance of not qualifying. They are the group who will be left uninsured since they are exempt from the mandate based upon income.
Any time some politician or (quasi-public person) wants to promote a policy, they claim it is for the benefit of the middle class – even when it is obviously not.
Mr. Roosevelt, Re your comment: “the bad news is that for many, health insurance continues to be a “grudge purchase.”
Not purchasing health insurance is an affordability problem for most and whether it’s Commonwealth Care or Commonwealth Choice, these premiums are NOT affordable for the majority of the uninsured residents of MA not to mention the fact that the coverage is inadequate. To wit, the largest number of enrollees are in the freebie plans and enrollment drops off from there as the premiums become more expensive.
As there is no cost control built into this endeavor, the affordability issue will be exacerbated in 2008 with the recent news that the insurance companies are already
seeking a 10 to 12 percent increase AND the Bronze plan – the least expensive with the most enrollees in Commonwealth Choice – will be discontinued as of January 2008.
(I wondered for a long time why this plan was even being offered since it didn’t appear to meet “minimum creditable coverage” and it didn’t occur to me that the Connector
would get into bait & switch so early in the game.)
If there’s a shortfall in the number of enrollees now, just you wait. The Connector just hung the Bronze-plan people out to dry and that fact, included with the impending
increase in costs and scaling back in coverage in order to keep the premiums “affordable” by the Connector’s unrealistic affordability tables, it’s over for this puppy in the not-to-distant future.
The sad part of this saga will be that many will have been hurt by this ugly law and the state will have wasted billions of taxpayer’s dollars that could have gone into real care for people and/or affordable housing and food banks.
If you think people don’t want health care then wake up. People can’t even pay their heating bills, food bills and utilities and the number of foreclosures in this state and the rest of the country is astronomical so health insurance isn’t exactly a priority item. Do you read or listen to the news or do you just tune out because none of this affects you or the people you call your friends?
Re your comment: Many are simply unaware of their responsibilities going forward, and the costs that they will incur if they choose to ignore the mandate.
You are dead wrong. People are very aware of their responsibilities. First and foremost, they need to have a roof over their heads, food in their bellies and heat during the winter and must provide the same for their children. Do you really expect people to stop heating and eating so they will have the cash to pay monthly health insurance premiums?
For hundreds of thousands of residents in this state, that’s the choice that has been placed before them by the backroom players who put together this faux health care reform and the legislators who allowed themselves to be railroaded into passing it which, by the way, doesn’t excuse them. I say this because in so doing, they created a paradox for themselves by passing a law when they knew that most of their uninsured constituents would not be able to comply.
Re your comment: Instead, we need to be engaged in a large-scale public education effort on what it means to remain uninsured in 2008 and move people towards the goal
of universal coverage.
If all you can talk about is “educating” (translation: intimidating) people about the penalties given the GROWING economic hardships low-to-middle income people in this
country INCLUDING those who reside in MA have been facing for the past five years, then you certainly show your true colors. The fact of the matter is that the penalties
will also cause a hardship for people, but as I already mentioned, you must not be tuned into the real world or maybe you are just plain ignorant.
In my opinion James RooseveltJr. and others in his income bracket have no idea what it’s like living pay check to pay check will not and cannot understand.As he is President and CEO of Tufts Health Plan what does he know about the struggle to survive the rest of us are going thru?His only interest is the bottom line for Tufts and he thinks if he comes to post threats we will buy into bogus insurance plans.We might not be wealthy but we’re not stupid.The sooner the Commonwealth Connector and all these so called smart business people realize “WE ARE NOT STUPID” you all can stop the threats because we are not buying into “no health care insurance plans” I never voted any of you into office so where do you get the power to tell us what to do?
Good job, Mr. Roosevelt! I feel so much safer knowing that, by the time we’re ready to plant our tomatoes, I’ll owe this greedy machine $600., which would be enough to get my trusty rusty pickup truck back on the road. Or cover our surprisingly reasonable auto insurance for 6 months. (As an aside, we’ve no problem with auto ins. mandate: the prices are actually AFFORDABLE.)
The salt on the wound in this outrageous penalty phase would be that I’d still be uninsured – even if I had ponied up the dough for your gussied-up Pewter Plan.
We collectively ask the state – not grudgingly, “HOW DARE YOU?” These penalties, aside from being a blatant overuse of government/corporate power, reveal a greedy lust for power that is breathtaking in scope.
Only by refusing in large numbers will we, the people be able to bring this DOG down.
Unfortunately, Mr. R. doesn’t much care what people can or cannot afford. However, the lumpen proleteriat is not as stupid as he thinks. Thank you, Norma, for your comment.
With income tax revenues down already and going down further in 2007 thanks to many problems in this state along with the 125 plans that must be offered per this faux reform causing further decline in income tax revenue, only 3 percent signed up in the Commonwealth Choice plans as of Dec. and the fact that the Connector is counting on this crowd to foot the bill for all those $0 premium folks who came out of the woodwork – a mere $150 million dollar strain on their budget-o-rama, things don’t look so good.
However, the bad news is that the Feds want this to happen soooo badly that they may kick in under the table.
Has everyone heard about the 18 state agencies that will receive all our personal, financial and medical info over the Internet along with the Federal gov’t and Maximus, an international marketing company in the south who will maintain all the info to the tune of $72 million a year?
Did anyone give their informed consent for their info to be passed around? Highly unlikely because the Connector hasn’t informed the general public about this. Assumed consent? Who is the Connector to assume anything? We didn’t elect them to represent us.
Time to get on our reps for this one among other aspects of this law. Unfortunately, they aren’t in care-mode but when this thing starts to go belly-up, they’ll be the first ones to bail. Meanwhile, their phones will be ringing off the hook when the penalties start and the “insured” start finding out what’s in store for them. The new 1099-HC ought to start some public outrage which will get worse as time goes on.
Fasten your seat belts, people. The games are about to begin.
By the way, it’s really great that so many people now have insurance that didn’t have it before. But, unfortunately, the low-to-middle income people can’t afford insurance for themselves and can’t afford to subsidize them either with the penalties. Maybe Van Faasen will kick in some of his retirement package and Mr. R. can also help out. After all, it’s about shared responsibility, isn’t it?
My husband makes about 63,000 a year, after taxes are taken out that gives a 1000.00 a week to pay a 2100. a month mortgage, all our increasing high oil, electric ,gasoline, propane gas and oil are 3.00 a gallon, groceries have gone up, now I cant afford to pay for health ins., if I could I would already have it. We are in our mid fifties, we risk getting very ill because we cant get proper health care with no ins.We are not able to get any help because of our income, maybe we need to give up groceries in order to afford this, there is no money inour budget for this. Now we are being threatened to be further in debt with penalties, I think that avaibility help should be based on our 1040 taxable income and not our gross pay. It is not affordable, and I dont know what we are going to do because the money is simply not there. JC