New York Times Examines Massachusetts Individual Health Insurance Mandate
More than 200,000 previously uninsured residents have enrolled in insurance plans, but state officials estimate that possibly up to twice as many residents have not enrolled in any type of coverage. Meanwhile, enrollment in the state-subsidized health plan has been greater than expected, and the state program could face a $150 million budget shortfall if enrollment continues at its current rate. Concerns also have been raised about projections that state insurers plan to increase rates by 10% to 12% next year -- twice the national average for 2007. According to the Times, such hikes "would undercut the plan's secondary goal of slowing the increase in health costs."
Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, said, "We're going to be very aggressive in trying to get those numbers down to single digits," adding, "If we continue with double-digit inflation, I don't think health care reform is sustainable." Implications
The experience in Massachusetts "should be instructive to the presidential campaigns, and to officials in California, where Gov. Arnold Schwarzenegger, a Republican, has proposed a similar plan," the Times reports. Democratic presidential candidates Sen. Hillary Rodham Clinton (N.Y.) and former Sen. John Edwards (N.C.) both have proposed universal health plans that include coverage mandates, which they say are necessary to guarantee coverage for all U.S. residents and to spread the country's risk as broadly as possible. Presidential candidate Sen. Barack Obama (D-Ill.) has proposed a health plan that does not include a comprehensive coverage mandate and instead focuses on reducing costs, providing subsidies to low-income residents and mandating coverage for children, the Times reports. Obama has said an insurance mandate cannot be put in place before it is determined that coverage will be affordable.
Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Foundation's Commission on Medicaid and the Uninsured, said it has become broadly accepted "that an individual mandate is the only alternative to government provision of coverage if you hope to achieve universal coverage." According to Kingsdale, "There's good evidence, whether it's buying auto insurance or wearing seat belts or motorcycle helmets, that mandates don't work 100%." He added, "We're talking about how close you can get to 100%, and to me, it's pretty evident you can't get as close without the mandate as you can with it" (Sack, New York Times, 11/25). Massachusetts Businesses
While most Massachusetts businesses offer health coverage to workers, 518 employers have elected to pay a penalty rather than offer insurance, as required under the state's health insurance law, the Boston Globe reports. According to the law, companies with 11 or more full-time-equivalent employees must pay a penalty of $295 per employee this year unless 25% of their workers are enrolled in employer-sponsored health plans or the company offers to pay at least one-third of workers' individual insurance premiums.
The state required about 62,000 employers with eight or more workers to report by Nov. 15 whether they met the insurance requirement. Of those businesses, nearly 44,000 were small enough to be exempt from the requirement, and the rest said they already offer coverage. About 18,000 employers have not yet reported their insurance status, and the state will impose the penalty on businesses that do not report whether they provide insurance, according to state Commissioner of Health Care Finance and Policy Sarah Iselin. Iselin said the state expects many of those businesses will be exempt from the requirements because they have fewer than 11 employees.
The state will collect about $5 million in penalties this year -- "far less" than the $24 million previously estimated, "which could result in another financial shortfall for health care reform," the Globe reports. The state Legislature originally estimated that the business penalty would generate $45 million last year and $36 million this fiscal year. However, the state did not collect any of the penalties last year, and Gov. Deval Patrick's (D) administration then downgraded this year's estimate to $24 million. Although money from the penalty "is a small part" of the estimated $1.8 billion annual cost of the law, there are other signs of budget strains, including the pace of enrollment in the state-subsidized health insurance plan -- which could cost $147 million more than expected this year -- and proposed federal rules that could reduce Medicaid funding by more than $100 million.
Some advocates have called for stricter rules on businesses, saying that employers should be required to provide coverage to at least half of their work forces and contribute more to premiums. John McDonough, executive director of Health Care for All, said the rules set forth by the administration of former Gov. Mitt Romney (R) have "permitted many employers providing little or no coverage to their workers to escape fair share responsibility. For example, if I offer to pay one-third of the premium and none of my employees take up the offer, I escape liability under the law even if I'm not covering anybody," adding, "This means that taxpayers are carrying and will carry a larger-than-anticipated burden." However, state Senate President Theresa Murray (D) said, "Employers are obviously doing their part, and individuals are also taking their responsibility seriously" (Dembner, Boston Globe, 11/22).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
New York Times analizeazã Massachusetts individuale de asigurãri sociale de sãnãtate Mandatul - New York Times Examines Massachusetts Individual Health Insurance Mandate - articole medicale engleza - startsanatate