John McDonough points to some interesting, and encouraging findings on the new health care law:
Support varies for different elements: 88% support expanded MassHealth coverage for kids; 70% support requiring business to provide health insurance or to pay a penalty; 52% support requiring all uninsured residents to purchase health insurance.
The mixed support for the individual mandate is income related higher income folks support at much higher levels than lower income folks. The question was worded to suggest that the penalties will be assessed on everyone Chapter 58 actually requires that penalties for non-coverage only fall on those for whom purchase of coverage is not [must be a typo — “not” should be deleted] affordable (definition to be determined by board of the Connector next year).
The full report from the Blue Cross Blue Shield Foundation can be found here. (And no, I’m not at all convinced that the BCBS Foundation is a straight-up shill organization for the insurance industry. From what I know, it’s more complicated than that.)
John has consistently contended that the personal mandate will not fall on those least able to afford decent coverage. I have to think that he’s right about that: I cannot imagine anyone in the legislature getting excited about requiring folks making $30,000 a year to buy a $350/month health plan. But the question then remains: What do you do about those “doughnut hole” of folks who make between, say, $30,000 and $60,000 a year, and don’t have insurance? Are they just left out in the cold, as in the status quo? What is the income threshold for requiring someone to buy his/her own insurance — at great expense? What’s an “affordable” insurance plan for them? What about someone making $100,000 a year? You got a problem with making them get insurance?
And even more complicated, what’s the level of care to be expected from newly-created plans? Are they swiss-cheese plans, costing little and covering little; or does the state require more and therefore charge more?
This is why it matters who we elected Governor. We didn’t even have this discussion this fall, due to our media giving wall-to-wall coverage of Laguer and Songer and hypothetical garage-rapes. In any event, I sure am glad it’s going to be Governor Patrick weighing in on these issues — even if I don’t know for certain how he’ll act. Judging by the polls, he’s got quite a bit of wiggle room with the public in a variety of ways, including going easy on the personal mandate and perhaps even increasing the currently-laughable employer assessment.
In any event, it’s a big headache for all concerned.
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Surely that “not” isn’t supposed to be there…
Looks like it, but he is one of the few guys in Mass who know anything about Chapter 58.
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The act:
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Then, if those folks don’t get the insurance, they suffer a penalty that’s assessed when they file their tax return.
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A perverse thing about that is that, if an EIC eligible taxpayer fails to buy insurance, then DOR takes their EIC refund as a penalty!
I was at the JFK LIbrary for the annual forum on health access convened by the BCBS FOundation yesterday, as I’ve participated for the past 3 or 4 years (since whenever they started). Impressive how many resources and hard work have been and continues to be put into this.
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Valuable data indeed but biased to be sure.
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Look at the specific polling questions and, as Bob Blendon the pollster points out, you’ll see that support for the “Individual mandat especially” drops very significantly as people ar given info about the spefics (not just generally good-sounding general descriptions of the law).
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I hope you readers know that I want universal affordable and sustainable coverge to succeed as much as the next person (ok, well, maybe a teeny weeny bit more than some :), ) but a key component is “affordable”. And think of that in terms of affordble not only to individuals but to all of us collectively in the state (and the entire nation, one day I hope) as taxpayers and asmembers of a collective Commonwealth.
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I say biased for a few reasons. A biggy is that when I spoke with John Houlihan form the Urban Institute acoupleyears back about their work commissioned by the BCBS Foundation on the “Roadmap to Coverage” project that led to major elements in the new Chap 58 health law about why the Urban Intstitute’s various models for expanding coverage did not include a One Party Payer option (also referred to as single payer by some) he replied “because that is not a model that the BCBS Foundation wanted us to include”. That’s really too bad because it’s the financing mechanism model that holds our strongest chance of actually being able to rein in huge waste in admin spending, fragmentation and layers of frustrating bureaucracy that define much of our current system.
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Some might conclude that this direction given by the BCBS FOundation wcould be construed as an act of intellectual dishonesty, or worse, to prohibit one particular reform model from even being included in the mix. It certainly reduces the content of the discussion and many think that to be a gosh darn shame.
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But many good folk are involved in this process and their efforts are appreciated.
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I will say that it was a thrill to be in the room with Governor-elect Patrick. I am immensely grateful that I was able to speak with him briefly yesterday, as I did at some lenght in that same room at JFK Library last year.
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Yesterday I said “Thank you” to Mr. Patrick and gave him a personal note and some short reading materials on health reform in the state (as we know he was kinda’ busy over the past few months so might have fallen behind on some reading :),). These materials included a Globe Op-Ed piece “Health Plan needs dose of common sense” by Marcia Angell (former editor, New England Journal of Medicine) along with an excellent primer on state health reform “Healthcare Myths, Realities” by Sager and Socolar (health economist researchers at the BU Health Reform Program). Sorry no time to post links now; don’t want to be late to present on the new law to a group of small businessses in my community at their monthly breakfast, and then I’ll be teaching so if anyone else wants to/can post these that’d be a service to fellow readers.
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Another item from the event you likely won’t see in the major media (BTW does anyone know how much revenue the Globe takes in from health care advertising?) is the question I posed to the second panel about theissue of affordability that I discuss below. I also wove in the rationale for why the citizen’s health care amendment is so vital to ensuring the success of the stated goals of the project: increasing access to care, and that the importance of that goal is the reason why the lawsuit has been filed in a good faith effort to secure its 2nd due ConCon vote on the health care amendment.
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Lastly, in today’s GLobe Op-Ed on this issue the final 2 sentences merit lively discussion that I’ll try to start here
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…”If the Massachusetts coalition works through the inevitable implementation problems, this state will provide a model of success for the rest of the nation.”
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To many’s thinking “inevitable implementation problems” will surely include unsustainalbe costs on BOTH individuals and families through the mandate to buy commercial insurance, and unsustainalbe costs to all of us who are the Commonwealth (and I meant ALL, including individuals, businesses etc) as it is the state budget that is the LARGEST payer of heatlh care bills in our current hugely expensive (needlessly so) and wasteful system.
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Replies, thoughts, anyone?
are the single payer energizer bunny, no?
health care justice mountain lion.
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I can purr but watch out when I start snarling.
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And from years of practice and possibly some genetic traits too, I’m pretty sure-footed on rough terrain ‘tho have my share of scars and callouses from the journey.
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the bunny’s cute but not capable of much fierceness that I know of 🙂 and Energizer is probobly owned by some dasterdly company that is poisoning people in large numbers somewhere in the world 🙁
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btw “health justice” encompasses stewardship of how we/they spend our health care dollars.
…because the burden of this law frightened her so much. She had been through enough hardships. And, although her income was not high, she didn’t qualify for any kind of assistance.
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It is crucial that we know exactly how the gov determines whether or not an individual or family is eligible for assistance, how much assistance is offered, and what is considered “affordable.”
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I was really glad that, when Gabrieli was campaigning, he kept bringing up how ridiculous is was to require employers to pay $250 a year for each employee who wasn’t covered by insurance. What the heck would $250 do? Around here that might cover one week of insurance!
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I’m grateful that this forum is keeping us updated on this issue. I think it is enormously important, and I’m annoyed with the Mass. politicians for being so proud of themselves for passing this troublesome law without caring a lot more about the actual welfare of the people who go without health insurance.
As has been said, the personal mandate will only fall on those who are deemed able to afford the premium. That is still under debate and discussion by the Connector board, and I have to believe McDonough when he says it will not squeeze those least able to pay, but will rather fall on those who are able to afford insurance but keep themselves out of the risk pool.
Ay, there’s the rub!
We don’t know what that level is, yet. But you know as well as I that it’s not going to go over well to squeeze folks of moderate incomes. Higher income folks — into the pool, I say.
i.e. the people in the 30k (no longer eligible for state assisstance) to 60k (just beginning to get beyond the paycheck-to-paycheck) bracket also happen to be probably the biggest voting bloc in the commonwealth.
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so though much of the emphasis has been on those on the margins, might we see a middle-class backlash on the horizon? and who is it going to be directed towards?
— admittedly unencumbered by actual data — is that the number of well-off folks who could easily afford health insurance but choose not to carry it is quite small (though whenever any reporter finds one they always write it up, especially if said well-off person wears spiffy clothes and drives a fast car — makes a better story that way). It’s just not rational behavior, and most people are rational.
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My belief is, and has been all along, that most people who don’t carry health insurance either (1) can’t afford it at all, or (2) could afford it but would have to make significant sacrifices elsewhere in their budget (Tom Trimarco’s outrageous “give up their cell phones” comment notwithstanding). The folks in category (1) should (in theory) be taken care of, since they will have access to free or very cheap health insurance, and they hopefully won’t be hit with tax penalties if they don’t buy in. But it’s the folks in category (2) that really worry me. I continue to doubt the wisdom of the all-knowing and beneficent State (now in the form of the ominously named “Connector Board”) making those kinds of decisions for people.
because this group that you refer to is set to become the new have-nots.
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whereas, single payer leaves no one out. especially on the basis of income.
resort to alternative medicine
i fused my thumb back together with duct tape and hydrogen peroxide when i split it down the middle with a hacksaw!
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rather than worry about losing a finger, i was standing in the yard trying to guess what the financial obligations of going to the emergency room were going to be. and if i should risk it.
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that’s not the position people should have to be in.
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(five weeks later, the homemade bandage came off. and i still have my thumb!)
Without driving too far down the single payer path, the US will not, IMHO, in the near future change to universal coverage.
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Best reason: Most (as in the ‘tyranny of the majority’ most) people are, are generally happy with the current system. Doctors are ok with their income, people ok with the choices, drug companies happy with their profits, there’s abundance of the tests and drugs, co-pays are annoying but not awful, blah, blah.
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Those who are unhappy with the current system, are in the minority. Add up the votes.
this is one of the best arguments I have heard. Reading it a few months ago changed my opinion of the new law from ambivalence to disapproval. The short version of the linked discussion is that a young man does not have health insurance but also doesn’t use health services.
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He did a cost benefit analysis and found that even under the “affordable” premiums the state is offering he would save himself significant money over the long run, even if he was injured and forced to seek emergency treatment. As a young and poor man myself I can certainly relate. The young and healthy are being forced, against their will, to pay for the care of the old and sick.
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Don’t get me wrong, I am all for health insurance, but forcing people to contract with a private company – especially when it is not in their interests to do so – strikes me as wrong.
you’re forced to buy auto insurance if you drive and forced to buy home replacement value fire insurance for a home.
Whats the option with health insurance?
There’s no option with health insurance.
Depends on where you live. I love David, who makes this argument often, but it’s pretty far from reality if you don’t live near public transport.
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The argument by analogy is weak to begin with, though. If you think health care is a social good, then you need everyone in the risk pool. It’s a reasonable question to ask whether that should be a public or private pool, but I feel strongly that everyone should be in it, for moral and actuarial reasons.
Logically, you’re right. Somewhere in threads past, you, or others similarly argued.
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Just by existing in this State, a law requires you to contract with a private party. The health care statute is that unique.
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But, if you want get married, you have to have a blood test (from a private party). Don’t get married you say. It’s a choice.
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Want to drive, you have to have insurance. Don’t drive your say.
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Want to own a home, you have to have insurance. Don’t own a home you say.
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Send the kids to public school. Better get them innoculated as the laws require. Oh yeah, kids are a choice you say.
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Ya got me. The guy that doesn’t drive, doesn’t own a home, isn’t married, doesn’t have kids, doesn’t own a gun ’causes if he did he’d kill himself from the boredom and inability to function in today’s Massachusetts, is because of the statute being compelled to buy insurance from a private party.
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He’s being forced to do the responsible thing.
Or at least one of them:
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As you say “He’s being forced to do the responsible thing.”
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He/She deserves to get a good deal, a good value for their health care dollar, yes? NONE of us now, not as individuals, families, businesses, taxpayers, not as a Commonwealth are we getting what we need and deserve from the absolutely mind-boggling sums of money that are being spent in the health care system.
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Let’s get on track to look under the rug if that’s what it takes and really solve this thing.