A few days ago, the debate about how much of their income uninsured residents will have to pay for required coverage was an exchange of shouts and threats. Today, it looks like the Connector board will get unanimous approval on a compromise plan. W-B-U-R’s Martha Bebinger has some details and insights into how they bridged the divide.
MARTHA BEBINGER: As Massachusetts gets ready to impose mandatory health insurance, setting rules about how much uninsured residents will be required to spend on health coverage is one of the most difficult practical and political decisions. Earlier this week, there were dueling proposals. Major business and health insurance leaders told the Connector that the vast majority of the uninsured must be required to buy coverage, while religious, community and medical groups urged broad exemptions. Celia Wcislo, a union leader on the Connector board, says the diverse sides were both committed to covering the uninsured.
CELIA WCISLO: It kept us coming back at each other at points where we were very frustrated and upset. This need to get people insurance, to do it right and to be a model that other people can look at, kept us coming back at it.
BEBINGER: The compromise offers free health insurance to more of the lowest income residents. There are 2 improvements for those who earn up to $30,000 a year, and qualify for subsidized insurance. They will pay a little less, and adults with families in this bracket won’t pay anything extra for their children. The changes could cost the state an additional 16 million dollars to next year…although the Connector hopes to recoup some of that because fewer people would use the free care pool. For residents who must buy health insurance on their own, there is a sliding scale for incomes up to $50,000 a year for individuals, more for families. Health Care for All’s Brian Rosman says the plan is a milestone.
BRIAN ROSMAN: The proposal represents a compromise that we think makes tremendous strides in making the health care reform law work. We are over a major hump.
BEBINGER: The connector estimates that 99% of the state’s population will have health insurance using these affordability guidelines. That leaves about 60,000 residents for whom there will not be affordable health insurance available, so they won’t be penalized for not having it. Massachusetts Taxpayers Foundation President, Michael Widmer says that’s a reasonable number while still requiring that individuals share the cost of insurance.
MICHAEL WIDMER: I wish it were less, on the other hand, what the advocates wanted would have waived out most of the uninsured population and clearly that’s not health reform.
BEBINGER: Connector Director Jon Kingsdale says he thinks the compromise reflects a growing acceptance about the value of health coverage.
JON KINSDALE: While any payment for health insurance for people of low or modest means, of course is a burden. Being uninsured, which means emergency room or clinic care when things flare up as opposed to having a personal physician and comp benefits, its really not more affordable to be uninsured than it is to pay something and be insured.
BEBINGER: But while a wide variety of religious, civic and business groups may be in agreement, selling that idea to many of the healthy uninsured will be tough. John Kerr of Quincy is a full time musician who qualifies for subsidized coverage. But Kerr says even if he could afford health insurance, he is turned off by the idea that he’ll be required to buy it.
JOHN KERR: I don’t understand why something, especially in a free market economy, has to be forced on people in order to have privilege. That seems to be almost a paradox.
BEBINGER: For those who won’t face any penalties…the waiver is bitter sweet. Susan Butterworth is a 56 year old English professor at Salem State College who works just less than full time and isn’t offered health insurance. She earns just over $30,000 dollars a year. Matching her age and income in this proposal, there are no affordable health plans.
BUTTERWORTH: Which is actually a relief, because I knew I couldn’t afford it and yet there was going to be a penalty if you weren’t insured. So actually I’m happy about the waiver, but I’m still going to be uninsured.
BEBINGER: Those who aren’t as lucky, or unlucky, as Butterworth will be able to appeal the requirement they have health insurance. The Connector may begin discussing criteria for those appeals today.
I firmly believe that most of us here in the Commonwealth are committed to helping more of the poor and low income population have quality affordable coverage, but this cannot be done responsibly nore successfully for the long-term without rules to establish serious cost controls in order to get more value in EVERYONE’S coverage.
We must be honest with each other and with ourselves in this important reform effort: nothing comes for free, does it? To better understand where the money will be coming from, especially in light of the current >$1Bil state budget deficit, Ms Bebinger, it would be helpful if you would further clarify a few critical items for readers.
What is meant by “free health insurance” when you explain some of what’s in the new compromise:
“The compromise offers free health insurance to more of the lowest income residents. There are 2 improvements for those who earn up to $30,000 a year, and qualify for subsidized insurance.
Are the insurance companies going to cover this new larger group (those earning under $30k/yr) for “free”?
A similar question regarding the new larger sized group that will qualify for “subsidized insurance” (those earning under $50k/yr).
Who will be paying for these increased subsidies and where will the money come from? What is the anticipated amount for all of this “new help” people will be eligable for?
Most importantly, what rules exist now or will be set to assure that the money is spent with the highest standards of stewardship, ie minimizing admin. waste and other non-healthcare expenditures?
The MA Universal HealthCare Reform legislation and initiative is turning into a joke. What is Almost Universal Health Care anyway? I think that the Commonwealth of MA needs to remove the word Universal from its reform initiative and just call it: TOO BAD WISHING IT WON”T MAKE IT SO, NOT EVEN near, close to, nearby, on the verge of, like, approaching, in close proximity to, in the vicinity of, in the neighborhood of Universal Health Care. And the “Advocates (that) praised the proposal yesterday” need to resign because in no way do they represent the Universal Health Care Concept and or Program. AND BY THE WAY THIS “PRIVATE INSURANCE MARKET MANDATE” APPROACH IS SURE TO BANKRUPT THE STATE BUDGET AS WELL AS INDIVIDUALS, FAMILIES AND LOCAL TOWN BUDGETS. I GUESS WE NOW KNOW WHICH STAKEHOLDER GROUP COMES OUT ON TOP – TOO BAD IT ISN’T THE CITIZENS OF MASSACHUSETTS.
This just in via email from Dr. McCanne, a primary care physician, health policy expert, and leader in the group Physicians for a National Health Program (http://www.PNHP.org )who runs a health policy listserve.
Dr. McCanne’s below remarks are quite germaine to our ongoing work here in MA to create a just and effective HC system, especially in light of the grave concerns that I and others have about mandating people to purchase insurance that many will not be able to afford to use due to high deductables, co-pays and co-insurance that characterize the new Chapter 58 “products”.
April 12, 2007 from Don McCanne, MD
“Health care cost increases are a concern for all of us. But trying to slow cost increases by assessing financial penalties for accessing beneficial services only worsens the dysfunctional state of our health care system.
Eliminating administrative excesses, negotiating prices and fees, budgeting capital improvements, reinforcing our primary care infrastructure, and modifying incentives for non-beneficial or
detrimental high-tech excesses are all methods of controlling costs that actually improve the function of our health care system.
We can improve health care spending, but there’s clearly a right way and a wrong way. Why do we continue to insist on doing it the wrong way?”
—
To subscribe to Dr. McCanne’s health policy listserve you can send a message with subject or body ‘help’ to quote-of-the-day-request@mccanne.org
On its face, penalizing someone for not buying a product they can’t afford is unfair. So the Connector’s adoption of “affordability” standards is a good thing – an act of fundamental fairness.
But lets not kid ourselves. Today’s decisions are just the beginning of the discussion.
The Connector has just told 80,000 Massachusetts residents that last year’s reforms won’t do anything for them. They can’t “afford” the premiums on the high deductible policies the Connector has approved so they’ll stay uninsured.
But the real question is what happens next year? Without major changes insurance premiums will continue growing much faster than wages and tax revenues. The 80,000 who can’t “afford” coverage this year will have new company. And the number of uninsured will grow every year that premiums grow faster than wages – which has been every year but one since the 1970s.
We will have made progress by expanding coverage for our lowest income residents. That’s a very good thing. But moderate income folks and the aging and ill of all incomes will quickly find last year’s reforms have done very little to help them. Likewise for the 90% of Massachusetts residents who already had coverage but are facing the endless burden of skyrocketing premiums and shrinking benefits. Likewise the vast majority of employers who provide their workers the best quality coverage they can afford.
It was interesting to see the Connector staff with their Power Point presentation on affordability. As always one of the first slides reminds us that Chapter 58 is built on the Principle of Shared Responsibility.
The State is subsidizing coverage. Individuals are paying premiums. And employers are making their contribution. Somehow that sounds like the money’s coming out of three different pockets but in reality its the same pocket – yours and mine – in the form of taxes, premiums and lower wages to offset employer premium payments.
What’s missing in this blissful world of shared responsibility is the responsibility we all have to get the waste out of our health care system. A recent report by McKinsey Global Institute suggests that the US wastes 28% of our health care dollar. The MA share of that is over $17 billion – almost $2,800 for every man, woman and child in MA.
Before we write anyone else out of the “universal” health reforms of 2006, lets expand the concept of shared responsibility to include the hospitals, providers and insurers who make 80% of the spending decisions. Let them keep their fair share of the savings but pass a share through to the folks who pay the bills to make coverage affordable for the 80,000 we just shut out and for the rest of us.
Barbara Roop, PhD, JD
Affordability standards adopted under Massachusetts universal health care law
The Connector has adopted affordability standards which will lead to health care insurance coverage for over 99% of Massachusetts residents (see NY Times article and WBUR story posted on WBUR’s CommonHealth blog). CommonHealth commenters have been giv…
Please, will someone listen to reason?
The noble path to heathcare for everyone must preclude the status quo spiral of commercial insurance?
Why don’t they get it?
Hi Ann – sorry for the delay in responding to your questions about the story this morning.
First – the income limit for “free” insurance rises under the Connector’s affordability plan from about $10,000 to about $15,000 a year for an individual. The Connector estimates that an additional 27,000 resident will have access to government funded coverage with this change.
Second, for individuals who earn more than $30,000 a year, these is sliding scale that would determine how much is considered “affordable” for health insurance. You can see the tables, based on income and family size here:
http://www.mass.gov/Qhic/docs/Affordability%20Schedule.2007.doc
The draft affordability regulations and other presentations from today’s Connector board meeting at here:
http://www.mass.gov/?pageID=hicmodulechunk&L=1&L0=Home&sid=Qhic&b=terminalcontent&f=april12_meeting&csid=Qhic
Best, Martha
Martha,
I just took a look at the affordability tables, thank you for posting them. They are, not surprisingly, unrealistic.
Housing costs, childcare costs, school loans, costs of medicine for chronic conditions are just some of the significant variables that can make any of these profiles unworkable. But we all know this.
The voices of those calling for the dreaded Single Payor System are simply being ignored. Are we all that cowed by the insurance and pharmaceutical companies? It appears so. I hear the calls from many voices in this blog, but not one of the responsible parties is addressing the issue.
Until that, the only solution, is proposed, the rest of this is just a huge pile of chatter.
I know plenty of the ‘uninsured’. I long lived as one and currently have only catastrophic insurance myself. How do you think we do the math? Let’s see: I have regular bills to pay, have to feed myself and get to and from work. I want to save for a house/pay off college loans/send money to my family in need/start a business. I am healthy. So now I am supposed to pay $105/month for…..medical insurance that covers……what?
We just have to get real about this, and look to fix the real problems, which have nothing to do with insurance and everything to do with delivering medical care.