Massachusetts health care reform
Background
The United States is said to have reached a stage where the status of health care is precarious, primarily because of it is simply not sustainable anymore in an environment where there are just under 50 million US citizens uninsured, out of which Massachusetts alone accounts for a figure of about half million such cases. There are many business units, mostly the small ones, which are forced to drop out of the health care safety net because they cannot afford the costs.
The yearly rise of insurance premiums and the lack of clarity on product availability and suitable product mixes also prevent many first time insurance buyers from buying into health care benefits. These include part time workers and many who work at different jobs. What is more hospitals are obliged to offer health care services free of cost to those unable to afford insurance, Therefore the costs are prohibitive for both those who seek care and those institutions which provide it. (McDonough, 2000)
The state of Massachusetts alone bore the brunt of almost $1.5 billion toward health care bills. So, when the State of Massachusetts voted in a bill making it mandatory for citizens to buy insurance cover, it was only recognizing the fact that insurance reforms are a conduit for health care benefits at affordable prices and a well insured population also helps to bring costs down. Governor Mitt Romney ensured that over 500 million people in his state would be insured through the first ever law-stipulating individuals should obtain health care benefits.
In effect, Governor Romney knew what he was doing. The uninsured in Massachusetts number some way under 10% but once the entire population was covered, the benefits would roll out. Some of these would be the provisions for Medicaid m insurance at affordable premiums and exposure to various products would result, and the population would enjoy the cumulative benefits of a transparent program, which would be accessible by all.
The state promised to bring those with low incomes, ease of access to products and to bring in an environment where everyone was into the insurance habit. The highlights of the reforms included the introduction of the “Commonwealth Health Insurance Connector”. There were hugely subsidizing insurance costs to those who were uninsured at the poverty line levels. Coverage for all children from low to very low income groups to under the Medicaid program. The facility of Fair Share Assessment under which $295 per year would be ensured by the employers hiring over 10 employees but not providing insurance cover. This last feature was unacceptable to the legislature, which made Governor Romney’s resolve to make it reality, stronger. (McKenzie, 2007)
The reforms
Residents will have to reveal whether they have insurance coverage and will be assessed on affordability levels. Those not insured but easily able to afford health insurance would be penalized to the extent of foregoing exemption status on personal taxes. It is an issue whether the concept of fair share will really work with employers who in any case, do not provide insurance coverage. Then they would probably not pay even a fee a slow as $295. Employers not providing coverage will have to pay something called the Free Rider Surcharge in case their employees come under the free care category. Employers would now have to pay a surcharge even up to 100% of servicing costs if employees use free care for 5 or more times. Employers will be exempt though, from $50000, initially spent by employees on health care. The bill enables insurance companies and small groups of employees to come together under the Health Connector, which would be like an umbrella service for individual employees. On the other hand, individuals aspiring to health care benefits.
The Connector will negotiate rates and purchase good products using this advantage. The state hopes to eliminate the pool of dependents availing free care through the Health Safety Net fund. As insurance is extended to all, the state will now be free from the obligation of footing free care costs. Instead, the State was free to use this fund to enable the uninsured afford affordable products because costs can be kept low. As reforms are expected to be fully in place by 2009 the state may only have to eventually part with only a fraction of the costs to implement legislation. (Gorman, 2008)
The other side of the coin
Nevertheless, some quarters report that the 2006 health insurance Law promise s to be nothing more than an extension of barrack Obama’s own plans for medical reform, which he is using as part of his political armory. The fact is that all those in the Democratic Party also used this to their own advantage in the lead up to the presidential campaign. The Commonwealth Care program has more members now than when it started. The legislation has immensely benefited over 300,000 people who otherwise would not have resort to health insurance and care. There are those who criticize the Massachusetts HealthCare Law for making it more difficult for the middle class to access health benefits skewed as the program is toward those below poverty level. The middle class will now need to spend more to get insurance benefits and it really cannot afford the premiums, making it unattractive as a target group for the Bill. Cost wise the fallout has been high for the reforms as well over $800 million have already been spent on the program when it was estimated that costs would in effect go down from 2009 but it does not seem to be happening.
Governor Romney recently declared that the present fiscal would probably see an upward swing in costs to well over 50 % of the estimate two years back when the bill was passed. This too sounds politically diplomatic because health insurers say that premiums are insufficient and will have to be racked up. The Commonwealth Care appointed insurance companies had actually asked for an increase in costs but somehow managed to bring their estimate down to 10% of the increase they were looking at. That does not seem to be sustainable now and this could rise to 15 %. To make political impact insurers are told to can cost overshoots, which they will have to offset with, reduced benefits, which will make the reforms counterproductive, and healthcare seem even more expensive. (Wcislo, 2007)
Public Support
However, the public perception around the law is favorable. Opinion polls state that support has in fact increased to almost 70 % of respondents since the passage of the bill. People support subsidies and compulsory individual insurance and almost 400,000 citizens have insurance coverage now. The natural public sympathy seems to be in favor of fines of $295 on employers who refuse to opt for health cover for their employees. The public also support the offer of care to those people below Federal Poverty Levels. The public or at least 14% of its members think the law is successful in what it set out to achieve.
Presidential campaign
Riding high on the reform platform are the presidential nominees and at least one of them, Barack Obama, is expected to do more for the middle class voters who have watched their savings diminish and feel financially insecure. He is expected to deal with this issue. He should focus on health care, say observers. To people, health care and prosperity are interwoven. (Dembner, 2008)
Beneficiaries
The cynics point to out that the obvious beneficiaries are the insurers who hold the industry in their hands. The state itself does not seem to have created a route for it to earn the funds, which will help it, spread its benefits more. It relies on federal money and the big group, free care users to spread its network in Massachusetts. The dangers of over funding are obvious to those who see the bill as a crafty move to channel hard-earned money from individuals to the big insurance companies. The free care pool of funds, meant for charity care at hospitals seems to be diverted to the insurance barons rather than go to the needy. So, health care reform in the state needs all the players in the arena.
Massachusetts will be an example of the kind of innovative thinking and public engagement but it will also take sustained effort to set perspectives right and maintain them. More people than planned were signed up overstretching resources. The reforms did not entirely reach people. Insurance reform results in good values and comprehensive products, which reach beneficiaries. It was reported that hospitals serving low-income groups were facing constraints from truncated free care payments. This led to a funding program of almost $2 billion.
Legally the state is not allowed to look into internal company affairs so there the bill place s too much emphasis on the state machinery being overly concerned with insurance coverage of employees as it is not mandatory to do so. In addition, there is nothing in the bill, which is clear on what affordability means for people ineligible for subsidies. The premiums may involve a chunk of payment. The Commonwealth Health Connector’s role is ambiguous as far as what is needed to get a nod from it. Moreover, mentally challenged people are not eligible for the benefits the physically afflicted. (Longman, 2007)
Conclusion
Commitments certainly need to be kept to beneficiaries but that is not going to happen with the sort of confusion of interests this unique bill has seen in its passage. Because so much is made of this bill politically, there is likely to be fallout between intentions and results. The outcome of the bill will have to a large extent deal with the agendas often conflicting in the political arena. Turf wars could easily diminish the bill’s impact in is home ground if the impact is not controlled.
References:
Dembner, Alice; February 3, 2008; “Subsidized care plan’s cost to double: Enrollment is outstripping state’s estimate”; The Boston Globe; Retrieved in 30.08.2008 from http://www.boston.com/news/health/articles/2008/02/03/subsidized_care_plans_cost_to_double/
Gorman, Bela; January 2008; “Update on Massachusetts Health Care Financing Reform”; Health Watch, Issue No. 57, Society of Actuaries; Retrieved in 30.08.2008 from
http://www.soa.org/library/newsletters/health-watch-newsletter/2008/january/hsn-2008-iss57.pdf
Longman, Phillip; 2007; Best Care Anywhere: Why VA Health Care Is Better Than Yours; Polipoint Press
McDonough, John Edward; 2000; Experiencing Politics: A Legislator’s Stories of Government and Health Care; University of California Press
McKenzie, James F. Pinger, Robert R. Kotecki, Jerome E; 2007; An Introduction to Community Health; Jones & Bartlett Publishers
Wcislo, Celia; (August 2007); Lessons learned to date from the Massachusetts Healthcare Reform; New America; Retrieved in 30.08.2008 from http://www.newamerica.net/files/MA%20HC%20Reform%20Lessons%20Learned%20to%20Date%20Aug%2007%20FINAL1.pdf