Physicians for a National Health Program, a single-payer support group, is gathering signatures in an online petition opposing Connector policies on Minimum Creditable Coverage and the individual mandate. You can read the letter, which as of this writing has around 350 signatures, by clicking here.
Their letter gets it right and wrong at the same time. It’s too bad their serious critique of high deductible plans is marred by careless mistakes and false charges. Sloppy analysis is one reason single-payer groups are peripheral to health policy debates in Massachusetts. Here’s our take:
1. The criticism of “consumer driven”/high deductible plans is valid. By authorizing individual deductibles as high as $2000, and family deductibles up to $4000, the Connector is giving its seal of approval to plans that will unfairly saddle consumers with high out of pocket costs. A recent study by the Access Project, “The Illusion of Coverage,” shows the painful consequences of medical debt and substandard care due to inadequate coverage. We join the letter drafters in calling on the Connector to re-examine its definition of “minimum creditable coverage.”
2. Unfortunately, the letter demonstrates ignorance of the basics of MA health reform. The letter states: “The Connector is set to compel a 56 year old making $30,000 to spend $4,164 annually for the lowest cost policy. This coverage requires a patient to pay a $2,000 deductible before insurance kicks in, plus coinsurance of 20% for hospital bills and $25 for each office visit even after the deductible is met.”
Actually, an individual with that income is eligible for subsidized Commonwealth Care, which provides comprehensive coverage for an annual premium of $1260 ($105 per month), with no deductible, no coinsurance, and co-pays of $10 for an office visit. The letter gets a fundamental fact wrong in its rush to prove a point.
3. Even if the letter had specified a 56-year old with an income of 31,000 (who is ineligible for CommCare), that person would not be compelled to spend $4,000 for coverage. Under the Connector’s proposed affordability guidelines, an individual earning $30,631-$35,000 is only mandated to buy coverage if it’s available for less than $1800 a year, or $150 per month. So either way, the example isn’t real (The affordability schedule and other regulations are available by clicking here). No individual is expected to pay $4000 a year unless his or her income is over at least $50,000.
We are concerned that even over $50K, many older individuals will be unable to find affordable insurance. At this Tuesday’s Connector Board hearing, the ACT!! Coalition will urge the Board to add another “income bracket” to the affordability schedule so individuals earning between $50K and $60K yearly will not be mandated to purchase unaffordable insurance. We also will ask the board to exempt from the individual mandate any individual or family who would have to pay 10% or more of income for premiums, regardless of income. Also, the Connector is promising a robust and humane waiver process which will take into account other financial obligations.
4. Seems these errors don’t matter to the authors because their real point is to promote single payer health insurance as the only solution. If that’s really the case, the Connector is the wrong target, and the right target is the Legislature. Single payer legislation has been filed in every legislative session, to our knowledge, since 1986 (Sen. Sal Albano filed the first one), and has never received an up or down vote even in a legislative committee.
Regardless of one’s position on single payer – and HCFA is supportive – advocates, and especially physician advocates, should have a commitment to getting facts right and presenting them accurately and fairly.
The income guidelines are too narrow, our family already pays out of pocket for one plan and are almost at “catastrophic” for prescription co-pays (happens every year with diabetes and complications related to that and we cannot take advantage of any relief prescription plan b/c we are already covered) – we are not allowed to reflect that in the income guidelines – as the income tax deduction is a percentage and not the actual dollar for dollar payout. We pay both federal and MA tax every year and would like to see a little more equity in the health care department
Well, Doc, I did make a suggestion to the “connector” when I called.
I told them to stop banning “catostrophic” policies from the list of acceptable coverage, and to leave the $5 and $10 copay features to those with Hx of MI , DM, etc, and the rest of the “GOMERS” .
And DOC, if I was required to buy a $5 copay type of policy, you can bet your last Coulter(TM) counter that I would FIND a reason to visit an MD weekly, so as to get my money’s worth.
Cheers.
Those who find fault with the MA reform law, the Connector, the available policies, the costs/subsidies, etc. have some valid points. However, while imperfect, the improvements the MA reform law has made are significant. Certainly thing could theoretically be better. But those who criticize the initiatiatives would better serve the dialog by making real suggestions for improvements (including how to pay for more funding if that is their suggestion), rather than just sniping. Anyone can be a critique, but it takes knowledge and thought to make useful suggestions.
.” Under the Connector’s proposed affordability guidelines, an individual earning $30,631-$35,000 is only mandated to buy coverage if it’s available for less than $1800 a year, or $150 per month. So either way, the example isn’t real (The affordability schedule and other regulations are available ….”
As a healthy individual, I DON’T WANT a low deductable plan. I earn over 50k, and have made three (3) visits to health care professionals for purposes other than exams in the last thirty-five (35) years.
HCFA’s advocating low deductables and low copays is proof positive that the “individuals w/o health insurance often go bankrupt, etc” argument is a farce. Would a $2000 medical bill make anyone file for bankruptcy? Court and attorney fees would exceed that. The real reason for implementing mandatory coverage is to get healthy people to shoulder the burden of those with chronic health problems, and you know it.
I recently called a rep at the “Connector” and argued my point. He did not dispute it, saying instead that “no system is perfect”.
Me think thee doth protest to muc.
(1) The affordability regulations are only PROPOSED – they are not in effect. Since they are not in effect yet, that 50 year who is only making 300% FPL plus 1 cent ($30,631.01 to be etremely precise) is still obligated to buy something.
(2) In 2006 when this was being put together, 300% FPL for one person was $29,400.
Yawn, you are quibbling over whether or not the nuer was round off.
I have been tracking the MA plan ever step of the way – and report the policy developements, implentation results, and all the other data to the head of the governor’s committee on the uninsured of my state which is working on a proposal for Medicaid.
In fact, today we were discussing the proposed regs, the exemptions from the mandate, the income profile of the uninsured, those enormous deductiles and the premiums. There isn’t much about the MA plan that hasn’t brought the reaction of “that won’t work”, “people who are uninsured can not afford those premiums”, “the coverage is lousy” (the YAP plans) and “they must be out of their minds with those deductibles – that is catastrophic coverage only and the incomes of the uninsured can’t pay that so they are still effectively uninsured and out the premiums.” Can’t recall anything favorable being expressed about the details of the MA plan – and that from the officials who are working on etending coverage in this state.