There is discrimination in the Commonwealth Care program as well. Eligibility and affordability is based on the total income shown on line 22 of Federal Form 1040 which doesn’t take into consideration self-employment tax and/or alimony paid out as part of the equation – monies that a person no longer has – whereas, taxpayers earning more than 300% FPL use line 37 for the Commonwealth Choice plans. MassHealth personnel say that payroll taxes are not taken into consideration for any applicants, however, the self-employed pay at least twice as much so have less “take-home” pay.

Furthermore, self-employed residents applying for Commonwealth Care are required to submit the prior year’s tax return as documention in lieu of current pay stubs which, of course, they don’t have. Chances are income in the current year for a self-employed person is not the same as the prior year, and in many cases has decreased considerably. Also of note, monthly incomes of the self-employed are usually sporadic with next to no income or none at all for a stretch of time, so these taxpayers must spend countless hours on the phone notifying MassHealth of an income change, proving it and switching from plan to plan – a bureaucratic nightmare that takes precious time and energy away from trying to earn a living.

These stipulations must be followed by MA because in order to receive the Federal funding, Commonwealth Care must follow MassHealth regs which also include an estate recovery program although the powers-that-be would like us to think that the new text added to the estate recovery clause – Under current practice, this does not apply to Commonwealth Care – suffices. Unfortunately, residents won’t know if current practice changed 3 days before they’ve signed the MBR or 3 days after – you get my drift. Thus, residents at 300% or less FPL are forced to purchase a policy in which the terms might change, and if the terms do change, said residents probably won’t be notified about any change in terms and don’t have a right to drop the policy anyways. There are also real estate liens which aren’t mentioned on the MBR.

This begs an answer to the question: Are these [Commonwealth Care] health insurance policies or loans? The Connector, MassHealth and some in the Patrick administration continue to dance around this, when, according to CMS, estate recovery is a Federal requirement for government-subsidized health insurance. Whether or not a state regulation must be changed to allow Commonwealth Care to recover assets is not known to me at this point, however, if so, I bet cash-strapped MA is seeking a way to do this.

Commonwealth Care members have little to no choice of doctors, that is, if they can even find a doctor who will see them because the reimbursement rate is so low. In the area where I reside, a privately-funded clinic founded to provide services for the uninsured long before Chapter 58 saw the light of day has temporarily taken up some of the slack with regard to Commonwealth Care members. Of course, this is at no cost to taxpayers because, as mentioned, this clinic is entirely privately supported, and services are provided through volunteer doctors and other health care professionals.

MA politicians should have taken physician availability by region into consideration BEFORE passing this law. Why should residents be forced to purchase a product that doesn’t deliver? In the real world, there are laws and remedies to protect consumers from this. Furthermore, disguising this problem as “the need to train the newly-insured to find a PCP and not use the ER” is unacceptable. If you need a doctor and can’t find one, where else would you go?

Fines for businesses that don’t offer health insurance are considerably less than the individual mandate – $295 per uninsured employee vs up to $912 per individual for 2008, $1,068 for 2009 – and businesses can easily find loopholes and avoid the mandate, leaving employees hung out to dry. It’s always a good idea to tread lightly with regard to the entities that are needed to garner and maintain the support required in order to pull off a scheme such as Chapter 58.

These inequitites and discriminations in the contract that MA has with its residents to purchase health insurance or pay penalties are numerous, and appear to void or exploit our rights. The integrity of the contract also seems questionable in that it forces people to purchase a specific product under duress, circumvents ERISA and HIPAA, creates a graduated income tax in a flat-tax state and violates our Fifth Amendment protections against self incrimination (Form 1099 HC).

As of early 2008, Commonwealth Care membership had a net decrease of 4,097 since inception while the net increase in Commonwealth Choice was 150. As of mid December 2008, at least 72% of the 162,726 enrolled in Commonwealth Care received the insurance for free. Approximately 15% pay a very small premium with 12% paying a substantial amount. These percentages clearly show that the subsidized insurance is not so affordable. Commonwealth Care members are also struggling to continue payments, and many cannot afford the copays which is also a problem for wage-earmers above 300% FPL. Nearly 300,000 residents still remain uninsured including tens of thousands unable to afford the available plans who received temporary offical state permission and about 90,000 who were exempt from the mandate because the Connector had no affordable insurance plan for this income range. Not included in the 300,000 are an approximate 10 to 15% who do not file a tax return and may be uninsured.

There are hundreds of thousands in MA who are currently worse off than they were before this law. Its success is but smoke and mirrors when one takes into consideration the large numbers who are being exploited and those who remain uninsured and cannot afford the penalties. Furthermore, the program is not sustainable, and penalty-payers and businesses cannot continue to prop it up. Many insured residents can’t come up with the cash to upgrade their existing policies to meet official state standards (MCC) and will be penalized in 2009.

Governor Patrick and MA legislators should be taking a serious look at what this law is doing to the hard-working taxpayers of the Commonwealth especially during this extremely difficult time. But, alas, politics is more important than the financial and personal well-being of MA residents and businesses.

Peter Quinn