Skip to comments.In Massachusetts, Universal Coverage Strains Care
Posted on 04/05/2008 7:32:48 AM PDT by socialismisinsidious
Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.
Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinsons next opening for a physical is not until early May of 2009.
Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the states new law requiring residents to have health insurance.
Its a recipe for disaster, Dr. Sereno said. Its great that people have access to health care, but now weve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.
Here in Massachusetts, legislative leaders have proposed bills to forgive medical school debt for those willing to practice primary care in underserved areas; a similar law, worth $15.6 million, passed in New York this week. Massachusetts also recently authorized the opening of clinics in drug stores, hoping to relieve the pressure.
Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.
I calculated that every time I have a Medicare patient its like handing them a $20 bill when they leave, she said. I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?
(Excerpt) Read more at nytimes.com ...
Mitt Romney wrote and signed the Mass. healthcare boondoggle.
I have a good buddy who is a doc, and who is a Dem despite all that. It just makes no sense to me whatsoever.
But hey! Look at the bright side! Under RomneyCare you can get your offspring killed for only fifty bucks!
Among many other liberal causes he supported all his political life - until he decided to run for pres. and yet some here want him as McCain's V.P. pick.. I suppose some want to see two liberals on the Republican ticket.
In Massachusetts, Universal Coverage Strains Care...
a strain this year...bankrupt next year .... more taxes to follow....great socialist system!!!
|Volume 354:2095-2098||May 18, 2006||Number 20|
In April 2006, Massachusetts enacted far-reaching health care reforms (see box).1,2 Starting in July 2007, all state residents must carry a minimum level of health insurance, a requirement that will be enforced through the state tax return. Coverage may be through an employer, Medicaid, Medicare, or new programs that will facilitate the purchase of private coverage. In many instances, failure to comply with the new law will lead to financial penalties. By 2009, the proportion of state residents who are insured should markedly increase.
Key Components of the Massachusetts Plan [http://content.nejm.org/cgi/content-nw/full/354/20/2095/T1]
The reforms follow months of intense discussions and have bipartisan support (see the article by Altman and Doonan in this issue). Many of the measures are creative and novel. For example, assistance in the payment of premiums will be provided for low-income persons and families who are not eligible for other public insurance. This assistance will aid in the purchase of insurance by people with incomes under 300 percent of the federal poverty guidelines, which in 2006 are $29,400 for an individual and $60,000 for a family of four living in the contiguous United States. For those who are ineligible for subsidies, the merger of the health insurance markets for small groups and individuals should reduce premiums, perhaps by 25 percent for individuals, according to state officials. A broader ability to purchase insurance on a pretax basis should reduce the net cost of insurance for those who cannot already do so.
Funding includes federal and state spending, as well as assessments on hospitals, insurers, and employers. Supplemental revenue to support the reforms is projected at $201 million in fiscal year 2008 and $173 million in fiscal year 2009, according to legislative analysts. This includes $125 million each year from general state revenues; the rest is from employers. When fully implemented, the reforms should represent a meaningful advance against the problem of the medically uninsured, even though only Massachusetts residents will benefit.3
The overall effect is harder to predict. The requirement is for a minimum level of health insurance, not an optimal level. Improving access to medical care for previously uninsured persons may increase the demand for needed services, such as surgery, thus improving health but increasing costs. The reforms may make little difference in many factors that contribute to spending, including the costs of prescription drugs and health care administration. There will be new roles for the state and federal government, individuals, employers, and health insurers and some new cost-control measures. Nonetheless, the overall structure of private health insurance and the payment and delivery of medical care will remain intact, and costs will relentlessly increase.
In 2004, the health expenditure per capita in the United States was $6,280, or more than $500 a month, and accounted for 16 percent of the gross domestic product. Spending grew by 7.9 percent from the previous year. In 2005, the average monthly cost of coverage through job-based health insurance was $335 for an individual and $907 for a family, according to the annual survey conducted by the Kaiser Family Foundation and the Health Research and Educational Trust. In Massachusetts, the average cost of policies is higher. Massachusetts has a long history of health care reform, including a controversial 1988 universal care law that was enacted but never implemented and that was eventually repealed. In the mid-1990s, the state expanded Medicaid and created a subsidized drug program for seniors.4 As compared with the nation as a whole, Massachusetts has a higher percentage of residents who have health insurance through their employers and a lower percentage of people without insurance (see Figure 1). Massachusetts already spends a considerable sum each year to compensate community health centers and hospitals that treat the uninsured, using state and federal funds, as well as payments from insurers and employers who are self-insured. Some of these existing funds will be redirected to improve insurance coverage. Although such favorable conditions suggest that the reforms have a greater chance of success in Massachusetts than they would elsewhere, officials still have to implement the measures and address the diverse situations of the uninsured (see Figure 2).
Funding includes federal and state spending, as well as assessments on hospitals, insurers, and employers.
Figure 1. Health Insurance Coverage in Massachusetts and the United States. [http://content.nejm.org/cgi/content-nw/full/354/20/2095/F1]
Figure 2. Characteristics of Uninsured Persons in the United States in 2004. [http://content.nejm.org/cgi/content-nw/full/354/20/2095/F2]
When Mitt Romney, the state's Republican governor, signed the health insurance reform bill, he vetoed some provisions, including an annual charge of $295 per employee to businesses with 11 or more full-time employees that do not provide health insurance or contribute to it. By early May, the legislature, which is overwhelmingly Democratic, had overriden this veto. The $295 charge is dwarfed by the annual cost of health insurance, and the anticipated revenues are only about $50 million a year. Although the so-called "fair share contribution" is not a substantial financial incentive for employers to provide insurance, it does symbolize the logic of the reforms that employers and employees share responsibility for health insurance.
Implementation depends on new regulations and insurance plans, as well as on the accuracy of many assumptions. One assumption is that the Centers for Medicare and Medicaid Services will approve the aspects that require its assent. These include the use of Medicaid funds to provide assistance to lower-income persons and families in the payment of premiums, expansion of Medicaid to include children of families whose income is up to 300 percent of the federal poverty guidelines, and continued support to Boston Medical Center and the Cambridge Health Alliance to care for people who remain uninsured. The waiver agreement under section 1115 of the Social Security Act allows the state to operate part of its Medicaid program under rules that are different from those that usually apply. Although approval is expected this summer, the federal government has not signaled its intentions. In any event, the waiver will expire in 2008 and will have to be renegotiated.
The estimated number of people without health insurance in Massachusetts ranges from 550,000, which is based on an annual state survey, to 715,000, which is the number provided by the Census Bureau for 20032004; state officials consider the higher number less reliable. The Massachusetts plan assumes that about 515,000 residents would gain coverage, leaving perhaps 35,000 without insurance. However, there is no certainty about the number who will gain coverage. In addition, if the actual number is considerably higher, the funding will fall short.
A new state authority, the Commonwealth Health Insurance Connector, will administer many of the insurance aspects of the reform and will have to approve the new policies before they can be sold. The target price of policies for low-income persons before premium-payment assistance is applied is $300 a month, which would be paid mostly by the state. These policies will have Medicaid-like benefits. They will not have deductibles, and there will be no premiums for persons who earn less than 100 percent of the federal poverty guidelines, or $9,800 a year. Otherwise, such items as the actual cost of insurance, the premiums after assistance is applied, out-of-pocket payments, and the extent of coverage will not be known until policies become available later this year.
A related assumption involves the availability of "affordable" insurance for people with incomes that make them ineligible for subsidized premiums. The individual mandate to have insurance is contingent on the availability of affordable plans. Although the term has yet to be defined, an "affordability scale" is to be set annually, by the connector. It is uncertain, however, whether the policies will truly be "affordable."
The insurance products are expected to offer coverage that is similar to the subsidized policies but may have important differences, such as deductibles, high-deductible plans tied to health savings accounts, substantial out-of-pocket payments, or more limited choices of doctors and hospitals. Although the Romney administration has set a target price of $200 a month for "comprehensive insurance" for an individual, state legislative leaders contend that the actual price will be about $320 a month. The features and prices will not be known until policies become available in 2007.
The Massachusetts health care reforms are ambitious and complex. State officials anticipate that adjustments will be needed along the way. Perhaps their most important assumption, however, is that the costs and economic burden will be acceptable in the long term. When the economy slows, state tax revenues decline. Simultaneously, Medicaid spending accelerates and the number of people who are either enrolled in Medicaid or uninsured increases.5 For the reforms to succeed, Massachusetts will have to sustain them through the economic hard times, when they will be needed most.
Dr. Steinbrook (firstname.lastname@example.org) is a national correspondent for the Journal.
Seems a big part of the problem is an independent State Agency (the Commonwealth Health Insurance Connector Authority and its Connector Board) which caves to pressure and rewrites the rules on the fly. Like any ‘good’ State Agency.
SALLY C. PIPES
At one year, Mass. healthcare plan falls short
By Sally C. Pipes | May 15, 2007
MASSACHUSETTS’S UNIVERSAL healthcare law turned one in April. To survive, its guardians have had to make many changes, each of which has increased current and future government spending, increased the government’s role in regulating the healthcare market, decreased individual responsibility to purchase insurance, and made certain that the plan will fall far short of achieving universal coverage.
The promise of the law was simple and seductive: Require people to purchase health insurance, make the insurance affordable, or at least tax-deductible, and then fine those who don’t comply. Subsidies could come from the current money devoted to the Uncompensated Care Pool and the federal taxpayers. Universal coverage, then, would be achieved with little new spending.
Numerous problems existed with this plan, but the fairy tale quality appealed to politicians and the national media, so it passed to much fanfare.
Interestingly, the Commonwealth Health Insurance Connector Authority, the bureaucrats in charge of implementing the plan, decided that the universal individual mandate does not apply to everyone, but rather only those who can afford the premiums. Therefore, nearly one in five of the currently uninsured will be exempt from the law.
The Connector Board also bowed to pressure and reduced the monthly premiums on the subsidized-but-not-entirely-free healthcare plans. This will increase the program’s costs by $13 million.
Even at these reduced rates, the plans will still not be attractive to many. People earning between 151 percent and 300 percent of the federal poverty limit — $25,000 to $110,000 for families and $15,316 to $50,000 for individuals — are expected to pay up to 9.6 percent of their income on insurance premiums, or pay fines. (This 9.6 percent is before any co pays and cost sharing.) Meanwhile, taxpayers are still subsidizing them by as much as 94 percent of total costs.
The structure is a gourmet recipe for runaway spending. With this level of premium, those who don’t value insurance enough to make financial sacrifice to purchase it will neglect to do so. The fine — set at $216 — will be more attractive than the premium. Politicians will be under strong pressure to not enforce the mandate once the fines increase to meaningful levels. Indeed, they have already shown their willingness to back away from it for the 20 percent of people, and have set up a waiver process to exempt others on a case-by-case basis.
At the same time, the massive premium subsidy will make these plans extremely attractive to individuals who expect to use large quantities of healthcare. The population paying the premiums will be older and sicker than the general population. Spending will explode. It will come from somewhere, most likely the taxpayer.
Early data already provide evidence of this dynamic. As of April 1, 62,979 individuals had signed up for Commonwealth Care, the subsidized plans. Of these, 52,500 were enrolled in the totally free option. Give something for nothing, and people sign up. The plans in which people have to pay are a different story. Sign-ups have been slow, and the people who have enrolled are older and sicker than those signing up for the free plan.
The average age of a person in the free plan is 36, while the average age in the paid plans is 47. Of the free plans, there have been 214 specialty referrals per 1,000 enrollees. Of the paid plans, there have been 416 specialty referrals per 1,000 enrollees.
The system is set up to tax the young and healthy — who typically have both less income and less wealth — to subsidize those who are older and less healthy. One goal, according to the organization Health Care For All, is “to create a statewide credible risk pool, so healthy people ‘prepay’ toward their medical care.”
The problem with this is that the young and healthy, who are already prepaying for Medicare out of every paycheck, may object to this new form of taxation. According to the state’s own data, it’s not the young and healthy who use the Uncompensated Care Pool or who abuse emergency rooms, so the real point is the prepay or taxation and subsidization of a so-called risk pool.
So one year in, we have a plan that, even if no more concessions to liberal advocates are made, falls 20 percent short of its stated goal. Its costs have already increased by at least $13 million and are on track to skyrocket by some multiple of this once the doctors’ bills start coming in. Happy Birthday.
Sally C. Pipes is president and CEO of the Pacific Research Institute.
The point of the legislation was to establish a more socialist government. Whether people got better health care was irrelevant and not important.
In the intervening two years since that article costs have gone up radically from what was estimated for Romney care and we have stories of health care rationing by inability to get service (as the story for this thread shows). It is not a surprise that universal insurance has led to inability to get care . . . that’s the function of a market . . . to make supply and demand equal through the mechanisms of price. When you remove that and require insurance, you get these results. Rationing of service through lack of supply (since demand has no cost — insurance is required regardless of whether you use the service or not) and higher costs for the socialist government who pays for the care since more people demand more care regardless of actual price of the care.
I did - after living there for 14 years - I lived in the Beautiful Berkshires - but the writing was on the wall - and that was 39 years ago.
where does the time go?
Due to State Agency interpretations and rulings to implement the statute. None of which have been challenged in a court. Maybe, someone running the program making the daily decisions would share the blame for its cost. Reading the second article I posted, possibly the Health Connector Board is the problem.
Conservative “Hero” Mitt Romney, and the Heritage Foundation begat this!?
I guess socialism is conservative these days, huh?
Government mandated, universal, compulsory healthcare . . . what could go wrong? /sarc
It’s a sort of corporatist vision. Health care unions, insurance companies, government, universities all represented on the board. Mussolini would approve!
And, which Massachusetts governor signed universal care into law? The same one certain conservatives were hailing as the conservative savior during the primaries.
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