A couple of super events could have been the Globe lead today—the Patriots are on the verge of becoming the greatest team ever…both Clinton and Obama plan to be in Massachusetts right before the greatest presidential primary ever. But once again, the Globe’s top headline screams health reform doom: “Subsidized care plan’s cost to double.”
Is this news? Is this right? Is this bad? Are there solutions?
On the newsworthiness issue, we’ll let readers decide for themselves.
As a factual statement, nobody knows, and nobody can know for sure. Of course, if a program doubles in enrollment, costs will probably double too. CommCare is still phasing in enrollment, and everyone expected the program to take several years to reach full enrollment. Forecasting enrollment and cost trends for health programs is difficult, particularly looking forward more than a year or two. There are so many unknown variables: medical inflation, employment rates, employer responses, federal changes. For example, the state has recently begun matching CommCare enrollees with DOR records, and disenrolling people with apparent incomes above their reported level. So we expect to see a short-term moderation in enrollment growth.
This is just an estimate. We can think of 3 reasons why the administration may want to estimate future enrollment and spending on the high side. One, they are seeking as much funding as possible from the federal government. A high estimate allows the feds to cut it back substantially, and still leave adequate funding for the state. Second, the Connector is this very moment negotiating over future rates with the 4 managed care plans that offer CommCare. Increased enrollment projection may allow the state to seek smaller per-person increases in the negotiations. And third, the Governor is looking at a number of revenue options, including casinos and closing loopholes. Again, a high estimate increases pressure for more revenue. We haven’t talked to the administration on any of these – they’re just guesses. But they may explain in part what’s going on.
The key variable, we think, is whether more or fewer employers begin to offer coverage to their low-wage workers. One model is that of Vinfen (not to pick on them), which dropped coverage for many part-timers in order to allow the workers access to CommCare.
When chapter 58 passed, we worried aloud that the employer responsibility leg of the stool was too short. As employers are virtually free to drop coverage or offer inadequate coverage, government must pick up the slack. But the stool legs could be readjusted.
One solution, we think, is to charge companies with substantial numbers of workers on CommCare. After all, if the state is providing the firm a significant advantage in terms of reduced benefit costs, it’s only fair to ask the employer to pay a portion of the state’s costs for covering their workers.
Is there a better alternative? We’ve heard nothing credible. The cost of failure would be much, much, higher. CommCare provides coverage to low-income uninsured adults who don’t have access to employer coverage, are not eligible for Medicaid, and cannot afford to buy individual coverage. The vast majority of enrollees were eligible for the “Uncompensated Care Pool,” mostly unmanaged care at hospitals and community health centers. This badly-flawed system is being replaced for most by a managed care system, with sliding scale premiums and copays, and more complete coverage.
We collectively as a commonwealth agreed to a moral imperative to provide decent coverage to those who do not have the resources to provide their own. Everyone (except maybe Governor Romney) knew this would not be cheap. The experiment is proving successful – possibly more successful than anticipated. Should we decry the cost, or congratulate ourselves and find ways to meet the challenge of success?
Brian Rosman
In response to Ann’s question, I think we can assume that the new group coverage is not much different than current group coverage in Massachusetts.
According to the Gabel survey of last fall, while nationally 59% of US workers have deductibles for their coverage, in MA, only 19% of workers have deductibles. This is true even for small businesses. Our average office visit copays are $15.
Of those in HMOs, overall 70% are very satisfied, and 27& are somewhat satisfied.
These and many more statistics are here:
http://www.bcbsmafoundation.org/foundationroot/en_US/documents/EmployerSurveyChartpack.pdf
I don’t know anything special about the new enrollees. Do you?
To Mike:
“I hope Norma, Ann, and all of you that consistently rail against the individual mandate will vote with that in mind tomorrow. Hilary is for a national individual mandate. Barack would expand coverage without it.”
Not accurate, Mike. Obama does support a health insurance mandate, on parents to cover their children. Not on adults. On children. A health insurance mandate nonetheless.
“Private Group: +106,000 – This is DHCFP’s count of the growth in people taking employer-offered insurance… Other states are experiencing a drop in employer coverage, while we’re going up.”
Thanks. Interesting. There’s still a vital set of missing details needed to understand this +106k number.
- What’s the quality of this insurance? Does it meet CH 58 MCC or maybe not yet and so costs likely to rise, both for employer and for employee?
- What’s the premium share cost to the employee?
- What are the deductible and co-pay costs to the individual employee?
- How many of these 106k individuals feel they are getting good insurance (affordable access to needed care) for a good value?
or put another way
- How many of these 106k feel they are not getting good insurance nor a fair deal but that they had no choice under the Mass. mandate law?
This is DHCFP’s count of the growth in people taking employer-offered insurance. It includes both employers buying insurance from the major insurers, and large companies who self-insure who use the major insurers to administer their plan.
It also includes some MassHealth members in private plans with premium assistance. For example, a parent may get help paying for their employer’s family coverage if that’s less costly than just covering the kids alone in regular Medicaid.
We think that this is mostly due to the health reform law. Other states are experiencing a drop in employer coverage, while we’re going up.
Thank you for the enrollment numbers. Can you please explain
“Private Group: +106,000″
Is this a part of the Connector Enrollment and the new law? If it is where does it fit, in Comm Care or in Comm Choice or where? Thanks
I hope Norma, Ann, and all of you that consistently rail against the individual mandate will vote with that in mind tomorrow. Hilary is for a national individual mandate. Barack would expand coverage without it.
Bob:
The numbers you cite are as of 9/30/07:
Newly Insured in 15 months.
(6/30/06 – 9/30/07)
Private Group: +106,000
Private Non-Group: -14,000
MassHealth: +48,000
Commonwealth Care: +115,000
Changes since then:
MassHealth is +90,000
CommCare is +170,000.
Not counting private enrollment increases, that gives a total increase in coverage of 352,000. At this point in time, the actual number may be higher or lower — no one knows. We’re pretty sure it’s substantially above 300,000 now.
John McDonough
Norma and other people.
Look hard and listen hard when they talk about this mess we are all in.
Use your common sense. Think about the money that all of us ALREADY pay for the health care system. I read that this state already spends way more than any other in the country but our people here are not any healthier and now look what is being done to people like Norma.
Insurance is not the same thing as health care. If you have to pay more money any time you are sick and you don’t have the money that is bad. My neighbor has the new insurance but says it was a trick because they made him pay a lot more when he broke his ankle at work. He can’t pay all the bills.
Where is all this money going
They try to bully us to think that this bad law in Massachusetts is all they can do. Like Mr Rosman who says “Is there a better alternative? We’ve heard nothing credible. The cost of failure would be much, much, higher.” The cost is killing me and my neighbors and my kids now so it fails a lot of people now so shouldn’t we do something about it.
the paper said thousands of people in Massachusetts still do not have health insurance and now the state is going to take their money because of it. That is a failure.
So many other senior citizen people I know cannot afford our medicine and still pay the rent or pay our heat bills. My son cannot keep the insurance they had because the boss is making him pay so much more the last 2 years. The boss says the company will go broke because the insurance price keeps going up so much every year. That is a failure.
Where does the millions of dollars Mr Rosmans group has to pay its people to say these things like there is not a better plan come from? How much money is from the insurance companies? How mush money is from the big hospital chains? Why else would they act like this.
My cousin in Alabama told me a better plan is to have a better medicare program to include all of us in every state so everybody will pay some like we already do and everybody will have health care.
She told me there is a group trying to make that in her state and in my state too and in California where our sister is. She said there is a group telling Mr Obama to do that and he might-look at their web site here http://www.HEALTHCARE-NOW.org. That sounds a lot better to me. Maybe to norma too.
About a month ago WBUR had a call-in show about our new healthcare law in Massachusetts. I expected to hear lots of calls from people who were happy that they finally had access to insurance.
I was wrong. All of the calls were from people who were angry and upset about being forced to purchase insurance that they couldn’t afford and felt they didn’t need.
I support universal healthcare and I support the goals of the Massachusetts reform. But it’s becoming increasingly clear that a backlash is brewing. We need to get the costs under control and do a better job of educating people about the value of health insurance.
This isn’t about statewide budgets. It’s about individual budgets.
Newly Insured in 15 months.
(6/30/06 – 9/30/07)
Private Group: +106,000
Private Non-Group: -14,000
MassHealth: +48,000
Commonwealth Care: +115,000
Source(Slide 4): http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/08/key_indicators_0108.pdf
What does that info tell you, Ann?
You comment that “As employers are virtually free to drop coverage or offer inadequate coverage, government must pick up the slack. But the stool legs could be readjusted. One solution, we think, is to charge companies with substantial numbers of workers on CommCare.”
Companies with substantial numbers of workers on CommCare would be those with large numbers of employees working part-time, or with low hourly wages, or both. These are people in entry-level jobs. Companies with a lot of people in such jobs might well move out of the state if faced with additional costs. If Gov. Patrick wants economic growth he should not impose any new charges on business that would damp entry level job growth.
Brian Rosman,
Please realize that the law is hurting alot of us,myself included.I am not a criminal because I cannot afford insurance,I cannot afford the fines.What do the citizens in my position do?If the law was designed to help why doesn’t it?If the fines add up and I can’t pay what happens then?To have this over my head is very disturbing to my well being.I would have never dreamed the State would create such a mean spirited law.I am not saying this because I don’t want insurance,of course I do but I simply can’t afford the insurance the State is selling.
Once again, will you please clarify how the total of 300,000 “newly enrolled” under the Ch 58 law is being calculated? Specifically, what’s the breakdown of MCaid, Comm Care, Comm Choice enrollment?
These details are needed for “We collectively as a commonwealth” to better understand what value “We” are getting with the huge infusion of new public money to purchase private insurance for some of the uninsured.
Then, once this information is made public (that elusive “transparency” concept that so many insiders like to say they support) and discussed honestly and vigorously, it might be possible for “We collectively as a commonwealth” to set this state on a path toward sustainable, affordable, and effective health system reforms.
Thank you in advance for the breakdown of MCaid, Comm Care, and Comm Choice enrollment, including the % enrolled in the different plans.
Go Pats!