Tomorrow, March 20, at 9:00 am, the Commonwealth Connector Board holds a public meeting at One Ashburton Place on the 21st Floor in Boston, MA to discuss whether all of the 7 approved state-subsidized plans will have to offer some limited scope of prescription drug coverage.
For more information about the limitations of the seven plans, please see my March 13 Blue Mass diary entry analyzing the affordability and scope of coverage for these 7 uncredible and unaffordable Connector-board insurance plans at Blue Mass Group. Alternatively, read the details of each of the seven approved plans on the Commonwealth Connector Board Web site at Commonwealth Connector Board and click on the Word document that is titled Connector Board Endorses Plans From Seven Carriers.
If you do not have health insurance or just care deeply about the fair and effective implementation of the state’s new health care insurance law, I urge you to let the Governor, your legislators, and members of the Commonwealth Connector Board know that the law, as currently being implemented, has serious affordability, scope of coverage, and punitive taxation penalty problems. The ability of Governor Patrick and his policy advisors to prevent these anticipated adverse implementation consequences from becoming another policy and mangement crisis for his administration later this spring and summer represents a key test of the effectiveness of the “new and improved” team working in the Governor’s office.
and I know, I know, I should, but I’m not too worried about it. I am young and indestructible and in prime condition. When I took my current job this May I turned down the health coverage because it was too expensive. With rent and student loans I am living paycheck to paycheck. Some months I end up with an extra $50 in my checking account, some months I am short. The idea of paying $150 a month for services I won’t use wasn’t a priority.
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Thats one of the reasons I oppose the personal mandate. I haven’t been for a physical in nearly 10 years. I haven’t had any kid of medicine in over 10, and no prescriptions in 20. The personal mandate exists so that the insurance companies can get money from people like me, who don’t use the services, and use it to pay for my grandparents, who will.
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I know its for the common good, and you can show me all the actuarial tables you want, but I simply will not be able to afford it. I make roughly as much where I am living now as I can expect to make when I move back home this spring, and the rents are comparable as well. The names of my employer and landlord may change, but my basic financial picture will remain the same. My income level will be too high to qualify for MassHealth, but too low to do anything but make ends meet. I’ll be taking the tax penalty instead.
And if you do end up in the emergency room, its my obligation to subsidize your care through the free care pool and the surcharge I pay on my health insurance, right?
…correct, but mean.
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The substance of Kai’s comment is why I prefer a health care financing system more along the lines of Germany’s. Everyone is required to have health care insurance. The government-organized system is required for people who earn below an income threshold, and optional for people above the threshold. The “premium” is treated as a tax based on income, up to a certain maximum. People earning above the threshold are permitted to opt out of the government-organized system, but, if they do, they have to get private insurance.
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The system ensures that everyone pays at least something into the system.
your house burns down, I suppose MY tax dollars go to the water to put it out. And when your Chevy Suburbans tears up our road, I suppose MY tax dollars will go to paving it over. And, despite the fact that I’m chlidless, I suppose MY tax dollars go to supporting the education of your kid. And hey, what about your tax exempt church?
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Look, I appreciate what you’re saying. The way we fund healthcare in this state right now is expensive, particularly when the uninsured hit the ER. But your “obligation” argument is dismissive of that fact that for very many people at the low end of the income scale, like Kai, additional healthcare payments are going to be a tremendous burden.
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By the way, if your a parent of a recent college grad living in Massachusetts, get ready for a few more frequent calls to the Bank of Mom and Dad when they start having to pay the premium.
If they would let me I would take out some sort of payment plan. I already owe more than 2 times my current annual salary in student loans, so whats an extra couple grand? If I couldn’t, and it exceeds the credit limit on my card, then yes, it I guess I would fall in the free care pool, though I don’t know nearly enough about how it works to say for sure.
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However, you can damn well be sure that should that happen, its an emergency. I’m very much of the school where just about any ache or illness can be walked off or drowned. For me to end up in the emergency room means I got hit by a bus.
…you don’t develop what might be considered a pre-existing condition while you are uninsured. If you do, you might find yourself uninsureable for anything for your entire life. There were reports of things like that in the LATimes several months ago.
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To use an analogy, insurance companies are loathe to insure a house after it has burned to the ground.
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Why take the tax penalty? I’m sure there’s a way to cheat around that penalty statute too.
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Seriously, ignore one law and obey the other out of what? You have personal principals to pay mandated taxes, but not mandated health insurance?
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Of course, then there’s this claptrap floating around that the health mandate is a unique and intrusive mandate for individuals to contract with a private party.
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Despite the faux libertarian wails, the individual is not unique. Massachusetts pioneered the individual mandate, requiring smallpox vaccine, from the local GP, of all residents at the turn of the 19th century, 1811.
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‘course, then was different. Smallpox was a crisis. People would catch it and die, unlike the health insurance crisis, where people who are uninsured, don’t seek or receive appropriate medical attention, and die.
Irrespective of whether or not individual human beings are unique (in some ways they are, in many ways not), they tend to live in communities. A community has a right to require its members to protect themselves against a readily communicable disease to, for example, inhibit the spread of the disease throughout the community. Vaccination can do that.
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Theoretically, if an individual does not want to do that, the individual could be banished, but the sad fact is that some members of the community–young people–who are susceptible to the disease don’t have the ability to make the choice regarding banishment. Hence, the requirement for universal vaccination.
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It pretty much is as simple as that.
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Vaccination is not without its risks. Quite frankly, the community, if it requires universal vaccination, should not throw the financial and other burdens of the risks onto those who care for those who succumb. That’s a different issue–but not that much of one.
Is the tax penalty a fine or a legal alternative. You’re treating it as the former, but I’m pretty sure that it’s the latter.
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If he pays the tax, then he’s not breaking the law.
Or, technically, it’s a penalty. I know this because the statute says so:
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blah, blah, blah.
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You can call it a “legal alternative”, much the same as paying a parking ticket is a legal alternative to obeying traffic laws, but I think we both know that’s a parking ticket is a fine.
….purposefully getting a parking ticket?
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i.e., let’s say i have to choose b/w garage ($25) or 50% chance of $30 ticket, so i take the latter.
Well, by say, double parking or not paying the meter, you respectfully piss me off or deprive the State of parking meter money.
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So, even though very minor, I’d say parking violations aren’t victimless crimes.
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…who administered the vaccine? The commonwealth? How was it paid for? The individual mandate requires that individuals participate in the health insurance market, requiring different people to pay different premiums to third party corporations. So, to that extent, the law has certain characteristics that make it look a lot like a taking.
Jacobson v. Massachusetts
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General medican practioner (A private party. Not sure why Corporation is relevant) administered it. Individuals paid for it. If they didn’t they had to forfeit $5.00 to the Commonwealth.
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I only offer this case as rebuttal to those who claim the individual mandate is unique. It’s not.
I hadn’t read it before, thanks for the cite.
I’m betting (my hard earned and too few dollars) that the tax penalty will be cheaper than the insurance will be. Believe you me, if I could get away with not paying that either I would. When I filed my taxes I certainly didn’t choose to pay the optional higher rate.
No question the penalty will be cheaper than the health insurance. You’re opting to break the law, and pay the (lower) price. I can rationalize that.
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Similarly, employers may hire illegal aliens because the employee demands a lower wage. Employer saves money. I can also rationalize that.
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Along the same lines, you may be able to embezzle from your employer. You may pay a price, but, if times are tough, and you’re willing to break the law and pay the price…. For some reason, I have trouble rationalizing this example.
even though I can’t afford to pay the fine.
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Then again, I can’t afford to follow the law on my own either, so where does that leave me?
Or begging for state permission to remain uninsured. Really, that’s in the law.
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Starting in ’08 individuals will have to pay 50% of the cost of an ANNUAL PREMIUM if they do not have insurance and do not fall in some donut hole category. It’s only in ’07 that the fine is limited to the tax refund penalty.
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Too many big pieces of this law are a bad joke. The employer community succeeded in getting Trav and Romney to squash DiMasi’s employer fair-share component of the law so that what now exists is even WORSE than a bad joke. Employers who don’t offer an insurance benefit have to pay a measley $295 per worker PER YEAR. While individuals get stuck for, hhmm, ten times that on average? Remember, the older you are the more you have to pay!!! 🙂
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And why wasn’t there an effort in the law to require insurers to prove better stewardship in how they spend healthcare dollars? Hhmmm, I wonder…
“It’s a grubby, violent, dangerous world. But it’s the only world they know. And they’re the only friends Eddie has.”
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Movie trailer for 1973’s Boston-basedThe Friends of Eddie Coyle on Youtube.
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Sorry to side track from the discussion, but I thought people would want to be let in on the reference.
Nice catch on the character reference, but before there was the movie and long, long before YouTube was invented, The Friends of Eddie Coyle was written by George V. Higgins, Boston’s most compelling crime and legal novel writer.
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If you enjoy James Ellroy, Raymond Chandler, or Joe Wambaugh and find Boston of the 1970’s fascinating, I recommend reading The Friends of Eddie Coyle and any other novel written by the incomparable George Higgins.
And the dialogue in the movie is very faithful to the book. They need to release the movie on DVD!
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Norman Mailer said of the book written by the federal prosecutor, “What I can’t get over is that so good first novel was written by the fuzz.”
eddiecoyle, glad you raised your points about Patrick’s role and the role of his team in this reform plan as it moves forward and needed adjustments are made to reach for, as you say, “fair and effective implementation of the state’s new health care insurance law”. The MSM is missing a lot of facts that the public needs to consider as things progress.
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Below are 2 recent Letters to the Editor on this hc topic that give useful perspectives and analyses, in case you missed them:
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Promises, promises in healthcare reform
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March 17, 2007
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PEOPLE OF all stripes are closely following the state health reform plan as it is rolled out. Many are beginning to feel that in fact it will be rolling over quite a few in need of affordable quality healthcare (“State OK’s 7 low-cost health plans for uninsured” Business, March 9).
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The utter irony of the quote from Jon Kingsdale, a former Tufts HMO executive and the executive director of the Commonwealth Connector board, is as tragic as it is absurd: “We want to get everybody in the Commonwealth using health insurance, but we also want to be humane and recognize the exceptions.”
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This statement amounts to applauding the law’s “individual mandate exemption” that will allow moderate-income state residents who lack health insurance to request a “humane” exception in order to not face tax penalties while receiving state permission to remain uninsured.
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ANN ELDRIDGE MALONE, Jamaica Plain
The writer, a registered nurse, is executive director of the Alliance to Defend Health Care
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and
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JAMES ROOSEVELT, chairman of the private insurers’ trade organization, dismisses worries about the affordability of the state’s mandated health plans (“Misinformation and fear muddy healthcare debate,” Letters, March 13). He trumpets the fact that plans without deductibles will be available. What he doesn’t say is that these plans will have huge copayments. In the “basic” no-deductible plan, patients will have to pay 35 percent of the total cost of hospital care, X-rays, lab tests, and outpatient surgery. Even a simple appendectomy would cost thousands out-of-pocket. Few of the uninsured could afford this, especially after forking over premiums of between $3,028 (for a 26-year-old) to $6,056 (for a 56-year-old).
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The Connector (the agency running the new health reform) and the insurance companies boast about the low-cost, quality coverage they’re forcing the uninsured to buy. But they admit, in insurance speak, that the new plans have 60 percent of the actuarial value” of a comprehensive plan. Stripped of jargon, this means the uninsured will get 60 percent of the coverage people like Mr. Roosevelt have for their families. And he could afford high copayments and big deductibles. Our patients can’t.
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Drs. STEFFIE WOOLHANDLER and DAVID U. HIMMELSTEIN,
Cambridge (AnnEM’s note: steffie and David are founders of, Physicians for a National Health Program
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There are a lot of folks and organizations across the state and the country with sounder solutions for covering the uninsured, improving hc quality, and for saving us all a bundle in hc costs. Thing is, these solutions don’t pander to the insurance industry… Anybody interested?
Wasn’t the intent of this law to help out the folks in the state who do not have health care, spread the financial pain around, unburden our ER/EMD’s and prevent some of our hospitals and health care providers from drowning in red ink?
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Is this going to be a disaster where the very people it is to aid refuse to participate, “You can lead a horse to water, but you can’t make him drink scenario.”. This will speak volumes for social programs where folks want the benefit but they refuse to contribute. Life ain’t a free ride.
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No one’s arguing for a “free ride”. A few thoughts on your questions re “…intent of this law to”
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1. “help out the folks in the state who do not have health care”
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-Yes. And great progress has been made by giving ~100k people living on near-poverty incomes ($9,680/yr) comprehensive insurance paid for by the state budget with a few folks paying a sliding scale premium. You’re right about nothing being free and poor folks pay in (sales tax, doing jobs we need done, etc), right? This past post “Nothing’s really free, is it? might interest you.
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2. “spread the financial pain around”
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-Yes, BUT. The employer community succeeded in getting Trav and Romney to squash DiMasi’s employer fair-share component of the law. What now exists is WORSE than a bad joke. Employers who don’t offer an insurance benefit have to pay a measley $295 per worker PER YEAR. Starting in ’08 individuals will have to pay 50% of the cost of an ANNUAL PREMIUM if they do not have insurance (in ’07 it’s only the tax refund penalty). And why wasn’t there an effort in the law to require insurers to prove better stewardship in how they spend healthcare dollars? Hhmmm, I wonder…
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3. “unburden our ER/EMD’s”
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-Yes, if more folks have quality coverage this will occur as folks go for prinary care and not put off care until an ER visit is needed. BUT, if what people have in reality is lousy Edsel/Coke coverage that they cannot afford to use due to high deductables, co-pays and the like, this goal might not be met too well.
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4. prevent some of our hospitals and health care providers from drowning in red ink
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-No, not very much in the law that I am aware of that addresses this problem. And it’s a huge reason why I and many other nurses I know will not tolerate working full-time in “the system” anymore. It’s a mess with countless obstacles put in the way of providing quality care to pateitns who need it. It’s a big reason so many of us are trying to change the entire hc system.
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MCRD, this past BMG post “Nothing’s really free, is it? speaks in detail to these issues. Lemme’ know what you think of it.
This white paper titled “Universal Health Coverage: The Problem with Individual Mandates” from The Century Foundation might be of interest. It ends on this note:
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“Some would-be health care reformers, like Halstead, start with a private insurance (individual responsibility) model and try to fix the problems that a competitive marketplace poses for equity and access. His individual mandates proposal reveals many of the difficulties with this approach. Others begin with a public insurance (social justice) model, like Medicare, and try to adapt it to deal with issues such as overall cost or overuse of health care. On balance, the latter strategy makes more sense.
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Leif Wellington Haase is a senior program officer and Health Care Fellow at The Century Foundation.”
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And this recent post on “GoozNews” titled “The Schwartzenegger Plan” is quite informative as well.
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If these analyses make sense to you, then I hope you’ll get involved in re-charting the course for MA hc reform by signing up at MassCare, and/or for national-level reform work at HealthCare-Now
Thanks.
They have to prop up a trillion dollar failing industry here. If you can’t afford medical insurance they are going to make you afford it.
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It’s a psychopathic law and everybody should ignore it. Somebody should challenge the Constitutionality of it.