Health Care for All of Us? What Chapter 58 means for the uninsured in Massachusetts

By now, we’ve all heard about Chapter 58 of the Acts of 2006, the landmark health care reform legislation.  Many lofty claims have been made about its accomplishments, and now that Massachusetts is first in the nation again in percentage of residents with health insurance, we have much to be proud of…but the trickier parts of reform are soon to be implemented.  The Medicaid expansions were clear in scope and asked little of “rational consumers.”  If you’re income eligible, you’d assuredly join. 

Similarly, if you’re not eligible but below 300% of the federal poverty level (“FPL”), you’re able to purchase your insurance through the state “Connector,” specifically through a program called C-CHIP or Commonwealth Care Health Insurance Program.  Individuals earning less than 100% of FPL have no premiums, with a sliding scale for individuals earning up to 300% ($29,412 for a single person, $60,012 for a family of four).  For more information on C-CHIP, check out the Q&A at: http://www.mass.gov/Qhic/docs/ccFAQ_122906.doc.

The real debate that will ensue on Beacon Hill in the coming months will be concerning the so-called individual mandate for coverage.  By July 1, 2007, everyone needs to have coverage; those without access to employer-sponsored insurance and small employer groups will be able to purchase affordable insurance through the Connector.  The enrollment period starts soon.

The problem for all sides is the definition of good value and high quality health care.  Under Chapter 58, the products offered by private entities through the Connector must meet “minimum creditable coverage” requirements set by the Connector.  The first round of insurance products submitted for Connector approval were virtually the same cost as traditional insurance products—for example, premiums averaging $400/month and a $2000 deductible for a single person.  According to one friend on the Connector board, the second round of products came in much less expensive—and more in line with what Romney and others predicted….closer to $200 in monthly premiums and a $1500 deductible. 

To get these products to become more affordable, insurance companies are reducing the “package” of what’s covered.  One of the big current debates concerns whether the Connector will require prescription drugs in “minimum creditable coverage.”  I certainly believe prescription drugs should be included, and believe the current administration can not only support this effort, but innovate on a variety of cost containment fronts in the drug markets, chiefly by supporting bulk purchasing strategies (Sen. Montigny and Sen. Jehlen have been champions of this approach), following the Maine Dirigo Health model of guaranteeing affordable drugs to these persons by tying them to the Medicaid formulary price, and finally, following Illinois and Wisconsin by assisting persons to purchase their prescription drugs from Canada and other countries. 

Springfield, which established a website for city employees, found that it saved between $ 2-4 million per year from employees who purchased their maintenance drugs through CanaRX. Approximately 1,200-1,300 employees used the program.  The City did not require they purchase the meds from Canada, but created an incentive by waiving both the co-payments (which ranged from $20-40 per order) and the shipping fee. The City suspended the program when it joined the GIC, which prohibits reimportation.

The administration should expect opposition from PhARMA, Mass Biotech and others who will argue that reimportation is simply importing price controls which will have a detrimental affect on drug R&D.  Yet we are the only developed country that does not negotiate drug prices with drug companies.  We simply can’t afford not to start negotiating better prices—and as a byproduct, offer our Connector-insured citizens quality coverage with a drug benefit.

As time goes on, we’ll all get a hang of the new reforms.  For now, however, keep your eye on the Connector Board meeting on March 2oth—at which time they’ll start making some important choices that will have a substantial impact on our uninsured citizens!  For more information, check out the following link:
http://www.mass.gov/?pageID=hicterminal&L=2&L0=Home&L1=Frequently+Asked+Questions+(FAQ)&sid=Qhic&b=terminalcontent&f=for_employers&csid=Qhic

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[Ron Norton]

This law is pure nonsense, it will enrich the greedy, parasitic insurance companies while providing nothing to consumers. Wake up! People want health care, not garbage insurance products.

[Celia Wcislo]

In the month of March, several major decisions will be made by the Connector Board that could impact you. The first is the definition of minimal credible coverage (MCC). Think of MCC as a minimum "wage" for health insurance. You will not be able to buy any insurance that is less than this minimum, for purposes of meeting the health insurance requriement of the new state law. You can buy more coverage, but not less.

The two largest issues we will be deciding on are how big the deductible will be for minimal coverage. A deductible is the amount you have to pay out of your pocket before the smaller co-payments kick in. Many of the insured in Massachusetts don't have deductibles, just co-payments. But for someone who has not had insurance before, this product will guarantee that after the deductible, your payments will be limited. Like having a deductible on your car insurance. We told the insurance companies that no one could offer a plan with a deductible of more than $2,000 a year for an individual. An additional issue wil lbe whether prescription drugs are paid for, or not. Many young adults who do not now have insurance, only have a sporadic need for prescription drugs. I personally think that we should be providing affordable drug coverage to all residents of the Commonwealth. The only way to prevent some diseases from doing greater harm is by medication. For high blood pressure, heart disease, diabetes, or some mental health problems, drugs are the major method of treatment in today's medicine.

Many of the ideas Senator Barrios has suggested are terrific and focus on cost controls. Some of them might take a year or two to be implemented, but if we start now, we could keep down the price of medications for everyone.

The second major question we will be addressing at the end of March is the question of how affordable the plans actually are for residents, and who will be covered by the law's tax mandate. Because the majority of people who are uninsured are below 500% of the poverty level, it will be important that we don't reach too far, too quickly. We should not be mandating residents into debt. Health insurance should be affordable for an individual, and protect them from the cost of medical care. The insurance SHOULD NOT push people further into poverty.

So far we have successfully signed up 25% of all the uninsured in Massachusetts, by taking a step at a time, and doing it well. We should do the same when we begin "mandating" everyone to buy coverage.

Let's walk before we run.

Celia Wcislo
Assistant Division Director
1199SEIU, Healthcare Workers East
Connector Board member

Check out www.bphc.org for a podcast that begins to explain the new law. Click on the section called "Health Click". It will be posted there, along with a version in Spanish.