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.