Here’s a well written piece by Blue Cross Foundation Pres. Nancy Turnbull, printed in the 2/16 edition of the Boston Business Journal. Subscription required, so here it is in full:

Don’t ignore broad health care progressby Nancy Turnbull

Massachusetts has the lowest rate of “un-insurance” in America. This is a headline worth shouting, but one that has gone unreported in the rash of recent media coverage of health reform. We obsess over every bump and rut in the admittedly rocky road of getting insurance to those without, but we never take time to toast our successes, which are striking. In the mere 10 months since the law was enacted, more than 100,000 people have gotten coverage through an expanded Medicaid program or the new Commonwealth Care program of subsidized insurance. Another 16,000 have applied for the latter program and will soon be enrolled. Those gains have lifted Massachusetts from the sixth best-performing state in providing its residents with health insurance to No. 1.

What comes next will be harder, as we knew it would be. One of the core assumptions of the reform law is that a voluntary health insurance system can never get Massachusetts to near-universal coverage. So the law mandates people to purchase health insurance if “affordable” coverage is available to them. No one likes a mandate. And setting the standard of affordability for this one is the most challenging aspects of the law. Initial information about the health plan bids for the new “affordable products” suggests the premiums may be substantially higher than predicted, with less coverage than many had hoped. And a recent report from the Greater Boston Interfaith Organization finds that a significant share of low- and moderate-income people may not be able to afford coverage under Commonwealth Care.

This isn’t surprising. Advocates have consistently cautioned that the Commonwealth Care premiums would likely be too expensive for many low- and moderate-income individuals. Given the current price of insurance, it’s a tall order to develop products that provide reasonable coverage and are significantly less expensive. But we are still in the early stages of meeting these challenges. The Commonwealth Health Insurance Connector Authority, the agency in charge of much of health care reform, has not yet negotiated actual rates with any insurer. And many uninsured are relatively young and would pay prices well below any average premium.

The good news is that, even if a sizable number of uninsured people cannot yet afford health insurance, we can still make substantial progress toward our goal of near-universal coverage. More than half of
low- and moderate-income people eligible for Commonwealth Care can afford the premiums, the Greater Boston Interfaith Organization report found, while an even higher share of those with higher incomes can afford private policies. That, along with the law’s expansion of Medicaid and expected higher uptake of employer coverage, would mean that 70 percent of the uninsured could have coverage by the end of this next phase of health reform. That would lower the rate of uninsured in Massachusetts to about 3 percent.

But to achieve these results we must find a way to get everyone who can afford health insurance to buy it. The individual mandate compels this participation. Retrenching on its broad enforcement, as some are suggesting, would weaken incentives for people to buy insurance and, in the absence of alternative strategies, undermine the impact of the health reform law. Any serious discussion of a broad waiver of the mandate must be accompanied by other strategies to achieve broad participation by the substantial number of uninsured people who will have affordable coverage available. The law already has yielded impressive results, and we can make even more progress if we can get the affordability standard and the affordable products right.

Nancy Turnbull is the president of the Blue Cross Blue Shield of Massachusetts Foundation.