Innovation in Massachusetts. Universal health care without a single-payer system.

Updates from around the blogosphere -

Mathew Holt:
“Either the insurers will not be regulated, and the market will implode with under-insured replacing the uninsured, and consumers and providers will be equally grumpy as it’ll all have been a head-fake. Or the insurers will be properly regulated in time, and the approach I suggest will be inevitable. And frankly that’s close enough to single payer for me to be happy so long as Mitt is . . .”

Hit and Run
“One feature that seems to be lacking in the Massachusetts legislation is rolling Medicaid and SCHIP monies into vouchers that allow the poor to select the private health insurance coverage they want. Of course, the devil is in the details, but ideally by experimenting with various health insurance systems on a state by state basis, the rest of the country can learn what works and what doesn’t. Still, this could be a way to avoid national single payer government provided health insurance, aka, completely socialized medicine.”

“I’m very interested in the exact details of this plan. My instincts at this time perceive several flaws in this altruistically sounding legislation. I am all in favor of affordable health care but the means to go achieve it as well as the end must both be just. To place higher economic burdens on the citizens of Massachusetts seems to be a move away from justice. Although affordable care that is truly for legitimate medical needs is a move towards the common good of society. As a good it should be pursued.”

Don Singleton:
“It does not matter whether they can afford to buy health care for their employees or not. I bet we find a lot of small businesses with 10 to 20 part time workers firing half their staff and having nine employees working overtime.”

The Editorials of E. Desiderius
“The plan does not socialize the system, yet provides multiple avenues to ensure coverage: raising revenue from business who do not provide coverage, encouraging and requiring the purchase of private insurance from those who can afford it, and covering those who are the most vulnerable and least able to pay for good coverage. And the plan does not create a situation where the standard of care in the state will be lowered dramatically, if at all.”

Kate Steadman
“What’s more; this is a major experiment. It will demonstrate how affordable these programs are, what major flaws the program didn’t for see, what major benefits the program brought, even how easy or difficult it is to get the chronically uninsured into insurance. Everything that goes on under the program will be carefully watched by universal insurance advocates.

I would, however, really like to see an EMR initiative along with this legislation, but I guess that’s too many birds to kill at once. Hopefully HIT pushes can be adopted in the next few years.”

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  • will quit soon

    There will probably be an exodus of small businesses from Mass. It will be interesting to see the implementation of this. Will ERs refuse to see those who are not covered in 3 years?

  • Anonymous

    Interesting to see all the criticism from physicians who also aren’t happy with the status quo. What does Mass have to lose for trying something different?

  • Kate

    Why would there be an exodus of small business? They’re only going to be penalized a paltry $295 per employee that they don’t cover. Compare that to how much it actually costs to insure employees, plus the cost of trying to move and set up their business elsewhere…

    it’s not going to happen.

  • Anonymous

    This will be a nice little experiment to watch. Even if it fails, there will be a lot that the other states will learn from the missteps. If it works and I hope it does, then it will a plan to emulate.
    I wonder, though, when those who will be insured for the first time goes to the doctor and find out that they are indeed insured but have a $2000 deductible that he/she has to pay and cannot afford because he/she makes only $35000 for a family of 4. Employers will have to purchase low cost HMO plans.

  • G. Hinson, MD

    The law (if signed) has made health insurance mandatory for all state residents , employeed or not, by July 1, 2007. If you are an employer, you will face an extra tax unless you provide the benefit. If you are the employee of a small business that cannot afford to buy insurance (or self-employeed), then you will be forced to do so, or else face an even stiffer penalty.

    As someone who (tries to) bills health insurance companies, I should be happy about this. As someone who is a proponent for a single payer system for universal health coverage (which this is not), I should be happy that this is a step in the right direction (what’s the old saying, “don’t let the perfect get in the way of the good”).

    But, I doubt there is anyone as happy right now as the large health insurance companies. They will profit greatly from this. This whole act rewards them and ignores what is, in my opinion, the biggest roadblock to affordable healthcare in this country, the extreme administrative burden caused by these same health insurers. The amount of money wasted in our current system would pay for the healthcare needs of everyone who is uninsured!

    This whole deal was put together by the large hospital organizations in the Boston area (who lose tons of money on the uninsured), health insurance corporations (lobbying to increase the size of their piece of the pie), and a governor trying hard to give everyone a reason to elect him president. On the surface, it looks like it is meant to help the little guy. But when the little guy is faced with the decision to buy a health insurance policy that does not provide that much coverage (even if it is a subsidized one) or else face penalties by taxation, only the insurance companies will be laughing.

    So I am going to withhold judgment on this until I see how this effects the number of people with employer-provided insurance. Businesses with more than 10 employees will have to either provide health insurance, or else face a $295/year/employee tax. Let’s see, pay BCBS $600/mos per employee or pay the state $295/year? Hmmm. This could end up giving employers an “out” to NOT provide insurance. Then the employees no longer covered can, if they qualify, get a state-subsidized plan. If they do not qualify, they will have to go out and pay even more for the same BCBS coverage (individual policies are much higher than those from a pool of employees) or else face stiff penalties from the state. Am I missing something, or is this going to be a huge burden on the middle class?

  • Anonymous

    I think it will be interesting to see how this plays out – not just in the short term but, say, 10 years from now.

    Maybe it’s not The Answer but what we have right now isn’t working too well either. Someone has to take a bold step here (although I’m glad I don’t live in Mass.)

    I’ve never thought it made sense to tie people’s health insurance status to where they work. It makes about as much sense as having employers provide car insurance or homeowners insurance.

  • Dan R.

    G. Hinson:

    After reviewing the law, sever articles, and your post, I think you maybe misinformed about what the plan does.

    The plan outlaws plan pricing on the basis of health status — thus its an adjusted community rating. The only major underwriting factors considered are age, sex, and tobacco use.

    In addition, it eliminates both private individual insurance and small group insurance. Essentially all small group/individual insurance will now be issued through a new state agency, which will treat all policies as a large group.

    Finally, each employee/individual covered through (not by) the state will have the ability to select their own insurance plan. Through required Section 125 premium only plans, they will also gain pre-tax payment advantages — even if their employer pays little or nothing.

    The $295/yr will go towards the employee’s premiums, which when coupled with state and Medicaid subsidies, will allow a significant discount to those under 300% of poverty level (30K / single person, plus 9K / additional dependent).

    The overall effects of this plan have yet to be seen — but I predict it will be positive. All employers will have to establish a Sec 125 premium only plan (figure 1K/yr + $3/employee/month), plus pay $295/yr to the state. Employers can contribute more, but that’s the minimum.

  • G. Hinson, MD

    Daniel, point me to your sources.

    “The plan outlaws plan pricing on the basis of health status…”

    This is already the case for our over-regulated insurance industry here in the state.

    “…it eliminates both private individual insurance and small group insurance. Essentially all small group/individual insurance will now be issued through a new state agency…”

    No it does not. It requires that everyone buys insurance from the existing private insurance options. The plan will expand Medicaid some for the lower income levels. The plan hopes to create more affordable insurance by increasing the size of the pool, but there is no real reason given to anticipate that prices will fall. I pay $11,000 a year now for my family, for a $4,000 deductible policy! A family of 4 making more than $48,000 a year will now be mandated to do the same.

    “The $295/yr will go towards the employee’s premiums…”

    The $295/yr, which emploters pay if they DO NOT provide insurance, is meant to fund all of the state’s added costs for expanding coverage to the lower income levels. It is really just a token penalty to businesses however, and I think it will make it easier for them to NOT provide coverage.

    It seems that we are reading too different stories. Here are some of things I have been reading:

    And always remember to follow the money:

  • Anonymous

    “Lobbyists for hospitals, insurance companies, and other major players in the healthcare industry were paid at least $7.5 million in 2005 as the Legislature took up a major healthcare bill, records show.”

    This cost of lobbying,of course, is passed on to the consumers.
    The first lesson to be learned from this experiment is that states
    must ban their state representatives and senators from accepting money from these lobbyists.
    The Boston Globe should publish
    the amount received by the state representatives or senators or Governor from these organizations.

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