Another Victory Declared in Massachusetts--The Connector Exempts 20% of Uninsured State Residents From the Requirement to Buy a Health Plan
The only place there are more victories being declared than in Iraq these days is in Massachusetts.
The Massachusetts Health Plan regulator, "The Commonwealth Connector," has issued new rules that will exempt an estimated 20% of the uninsured from a state legal requirement to purchase health insurance.
Since the health plan bids came in last month, it has been clear the prices would not make it possible for Massachusetts to be able to implement its mandate that all citizens have health insurance or pay a penalty.
Given what they are required to work with, the "The Commonwealth Health Insurance Connector Authority" has come up with a rational way to implement the mandate--such as it is.
Fundamentally, the problem they are dealing with is one of cost. Health insurance just costs too much in Massachusetts and everywhere else in our country.
Good for the "Connector" in that they have done as much as anyone could have.
Massachusetts is also being successful in expanding the number of people who will receive a full subsidy for a health insurance plan:
- "The income threshold for an individual who receives a full subsidy and does not have to pay monthly premiums for the Commonwealth Care health insurance program would increase from 100 percent of the federal poverty level ($10,210) to 150 percent ($15,315).
- "For those earning between 151 and 200 percent of the federal poverty level ($20,420), the monthly premiums for Commonwealth Care would be reduced from $40 to $35."
But let's not have any false celebrations here. The Massachusetts experience tells us that closing the uninsured gap, and covering everyone, is something that has a cost no state can afford on its own. While this is a practical solution, it is not an elegant one--or a comprehensive one.
Under the program, a family of three earning $50,000 per year will have a health insurance plan available to them but it will cost about $7,000--and that plan has a $2,000 per person deductible. Before the Connector's ruling on exemptions, that was mandatory. Now, a family making $50,000 is exempted from the mandate if it can't find a plan for less than $3,840 per year. Based upon the "Connector's" health insurance rates, they won't find one.
They are exempted from the mandate. Problem solved.
Well, not exactly. That family still doesn't have insurance and it won't. If that family could find the money, it would pay $7,000 and get a plan with a $2,000 individual deductible ($4,000 family). The plan does have some limited first dollar office visits.
A $7,000 cost for a plan with a huge upfront deductible is no great deal for this family. It is no better deal to have the state now say, "Never mind."
It's worse for older citizens in this age-rated program. A 56-year-old would pay $351 to $505 in eastern Mass for the $2,000 deductible plan. The exemption doesn't help them get insurance.
It's not always rosy for people who still find themselves under the requirement to buy a health insurance plan. For example, a couple making $41,000 a year would be expected to pay $270 per month or $3,240 per year for a plan with a $2,000 deductible--if they can find one for that price. Not a lot for health insurance but a great deal to be expected of a couple making $41,000 a year.
The lesson from Massachusetts is not that they have found a practical way to do comprehensive health care reform.
The lesson is that a state cannot do it all by themselves.
In Massachusetts, the good news is that the glass is half full--a lot of people will have coverage who didn't before particularly between 100% and 200% of the federal poverty level.
The bad news is that the glass is half empty--lot's of people have been "exempted" from the new universal health care coverage mandate but still can't afford it. And on this point, Massachusetts has hit one big brick wall--and they don't have the means to go further.
That isn't trash talking. It is the reality we all need to face when trying to understand what the Massachusetts health care reform law means to the rest of us.
You can get the full exemption scale at the Connector Website.
See my earlier posts on the Massachusetts Universal Health Plan
6 comments:
Not very good considering in the private sector of other states, individuals can purchase a RightStart Health Plan starting at $60.00 per month. This plan provides a low deductible ($500), office visit copay's and a prescription card.
MASS has a long way to go (if they ever get there) in solving the health care issue. Taking away market forces and putting health care in the hands of government is not the answer Americans are seeking...and never will be.
What are the constitutional legal issues with this law? I understand why car insurance can be required because the state is protecting the other drivers on the road from your mistakes. But what right does the state have to tell individuals how they must spend ther hard earned money, especially when they are struggling to pay the rent, keep on the heat and put food on the table. The real costs of this program have nothing to do with money.
Thank you, Robert, for not trash talking. For the record, the MA advocacy community has never once called the MA health reform law "universal" because it's not. If it gets our state's level of insured up to 98 or 99%, that's not too shabby, and puts us in a stronger position to eliminate the gap. We are the first to admit it's not perfect, and has many flaws. We're also the only state in the nation right now actively enrolling a ton of uninsured into quality affordable coverage -- 113,000 in the first 365 days.
We don't pretend to be a blueprint for the rest of the nation in policy details, though many states can learn valuable lessons from aspects of our experience.
The lesson we hope they learn is, get off your butt and start fixing the system whatever way you can. I was just in OK yesterday at a health forum -- half MA's population, and many more uninsured, and not a health reform pulse beating in the state.
By the way, checked out the "Right Start" health plan with its "prescription card" -- yep, a card, a $25 copay, 50% coinsurance, and a $500 deductible. Gotta luv it!
Thank you, John. For those of you who are unfamiliar with the nits in Mass, John is one of the principle players in getting the Mass law enacted.
I hope the Connector is right about the estimate that 98% of all Mass residents will be covered. That’s one we will have to wait and see happen.
One thing I can't question is you did get off your butt and do something. Good for you.
Good post except for your omission of a few pesky details such as the state's >$1.3Bil budget deficit and the related impossibility of sustaining funding for this approach to health system reform.
The budget deficit MA faced BEFORE adding the new state costs associated with this approach to expanding coverage was a big problem. It's much bigger now.
Now we have major increases in state subsidies to help cover the poor with private insurance through HMO's and to subsidize the new mandate that everyone must buy a private insurance product.
HC spending in MA is already more than $62Bil annually. This reform is largely a sham.
Yes, helping more of the poor gain coverage is a good thing and our group worked hard for that piece in it, but we also tried to not give away the store to special interests, ie inruance industry and powerful hospital chains. They won. The majority of the people in MA lost.
We are already being bankrupted and because of this are under-funding other important social programs due to our wasteful HC spending (per a state analysis, 39% of all HC spending is on non-HC expenditures!! "LECG Report" avail on MA.gov webiste)
Pity that no serious cost controls exist in the current MA reform law. There is no way under this appraoch that MA will come close to 98% having quality affordable coverage. And further tinkering around the edges won't get us there.
That coverage goal might have been achievable if the 4-year campaign to enact a healthcare constitutional amendment for "comprehensive, affordable and equitably financed health insurance" had received its two required up-or-down votes in the legislature. (campaign was underway 2002-2006 see www.HealthCareForMass.org for info ).
The citizens were denied the chance to vote on the HC amendment on the statewide ballot when the legislature, strong-armed by leadership, refused to grant it the second vote defying the state constitution and the ruling of the State Supreme Court. A case is pending before the SJC seeking a remedy to this travesty of justice (I am one ofthe 10 plaintiffs).
So if you wish to have a factual discussion about the MA health reform law I hope you'll share these facts with others. Feel free to contact me for further details.
Manyindividuals and organizations in MA are working hard to do much better in meeting the need for quality affordable healthcare than what exists in this misguided and misrepresented MA reform law. Visit the link with my name here to stay tuned on developments.
Please, please, please tell me that what I found out recently is not true - I am a Ma. resident and I have a friend who got 100% free health care. This friend is single, owns a large house almost mortgage free - and drives a Mercedes (has a Lexus also).
BUT, she "games" the system, trying purposely to make no money...although she has 100's of thousands in the bank.
Can you...or anyone...explain a system that lacks even the most simple means test? My state senator did not even respond to this question.
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