Massachusetts Universal Healthcare solution

[YellowLinesandArmadillos]

http://www.nytimes.com/2006/04/05/us/05mass.html?th&emc=th

 

This sounds great, except when someone starts gaming the program, either insurance cos raising rates through the roof, doctors ordering too many tests or patients drug seeking and then the House of cards falls.

 

My question is did they raise the penalities for fraud on collusion on all sides?

[KRC]

http://www.nytimes.com/2006/04/05/us/05mass.html?th&emc=th

 

This sounds great, except when someone starts gaming the program, either insurance cos raising rates through the roof, doctors ordering too many tests or patients drug seeking and then the House of cards falls. 

 

My question is did they raise the penalities for fraud on collusion on all sides?

653030[/snapback]

 

Several things worry me about this plan:

 

1) You are mandated to buy insurance. Who determines how much coverage you need to meet this quota?

 

2) Government subsidies to insurance companies?

 

3) If you "can afford" insurance, but choose not to get it, you are fined. The problem is that the fines (even for repeat offenders) are still less than what it would cost to get the insurance. Where is the incentive to get the insurance? You save money by NOT getting the insurace and just paying the fines. If you need medical care, the government is still picking up the tab.

 

4) What happens if the cheap insurance that you buy (you know that cheap plans which only provide the minimum coverage will pop up like crazy) does not cover your medical needs? Who picks up the tab, the people who are buying more "sensible" coverage or the taxpayers?

 

That's all I have after one reading of the article. I imagine I will have more as I read it again.

[VABills]

Well how many companies now will drop medical coverage, and these folks now get junk coverage.

[cromagnum]

http://www.nytimes.com/2006/04/05/us/05mass.html?th&emc=th

 

This sounds great, except when someone starts gaming the program, either insurance cos raising rates through the roof, doctors ordering too many tests or patients drug seeking and then the House of cards falls. 

 

My question is did they raise the penalities for fraud on collusion on all sides?

653030[/snapback]

Haven't read it yet, I wonder how many small companies will move to N.H. because of this bill.......

[Johnny Coli]

Several things worry me about this plan:

 

1) You are mandated to buy insurance. Who determines how much coverage you need to meet this quota?

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I haven't read it yet, either, but will try to find a direct link. It was all over the news yesterday, of course, so here's what I heard.

 

The amount of coverage you can afford is based on your gross income...so it will be determined when you file your taxes. They will supposedly have a database showing who has coverage, who doesn't, and what coverage they have.

 

There will be a sliding scale of affordable coverage...basically, if you're poor, you have to pay for something, but it doesn't mean you get screwed out of decent coverage just because you have the more cost-effective plan. Right now you have people of all income ranges refusing to get health insurance saying they can't afford it, yet still show up at the emergency rooms looking for free care. Those people will have to pay. The first year they are required to pay for at least half of the lowest-cost plan. But, the amount they pay will increase every year that they refuse to buy a plan. In the long run they won't be screwing the system, they'll just incur larger and larger penalties.

 

The only people who are exempt from paying are people whose income is 300% below the poverty level.

 

2) Government subsidies to insurance companies? 

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This I'm not sure about. I believe the subsidies are supposed to force health insurance companies to come up with affordable, low-cost plans that still have an acceptable number of healthcare benefits. That's all I know. There is a Boston Globe article detailing the amount of lobbying money that got tossed around while this was being hammered out, so make your own judgements about that until more info comes out.

 

3) If you "can afford" insurance, but choose not to get it, you are fined. The problem is that the fines (even for repeat offenders) are still less than what it would cost to get the insurance. Where is the incentive to get the insurance? You save money by NOT getting the insurace and just paying the fines. If you need medical care, the government is still picking up the tab.

653065[/snapback]

See the answer to this question above. It may be cheaper to screw the system earlier on, but you incur larger financial penalties the longer you do.

 

4) What happens if the cheap insurance that you buy (you know that cheap plans which only provide the minimum coverage will pop up like crazy) does not cover your medical needs? Who picks up the tab, the people who are buying more "sensible" coverage or the taxpayers?

653065[/snapback]

Not sure on that either. There will be a substantial pool of money from companies with 10 or fewer employees that refuse to provide some health insurance plan for their workers. That is set at $295/employee/year. That pool is supposed to cover some of the cost for care for the uninsured, or the less-insured. I believe children are still covered through Medicare.

 

 

While not a perfect plan, it seems like a good start. As in many states, there are plenty of individuals who can afford insurance that don't get it, and end up going to emergency rooms for free care. This plan makes everyone pay at least something.

[Johnny Coli]

UPDATE:

 

I found a committee summary of the report.

Link

 

 

 

UPDATE II:

Here's the Globe article on the lobbying and the interest groups behind it.

Lobbyists took in $7.5m on health bill

 

 

 

UPDATE III:

The Globe has a quick and dirty summary:

The Legislation

Here is a brief explanation of the legislation:

 

THE BILL: The healthcare bill is designed to provide insurance to nearly all the state's estimated 500,000 uninsured residents.

 

THE POOREST: Single adults making less than $9,500 a year will have access to health coverage with no premiums or deductibles.

 

THE LOW-INCOME: Those living at up to 300 percent of the poverty level, about $48,000 for a family of three, will be able to get health coverage on a sliding scale with no deductibles.

 

THE PENALTY: Individuals able but unwilling to purchase healthcare could face fines of more than $1,000 a year.

So, I misstated in a previous post. The sliding scale coverage goes to people up to 300% of the Federal Poverty Level (~$48,000, which in Mass is pretty low). People making below ~$10,000/year get covered for free, but if you're making that kind of dough you got other problems in this state than just your health.

Edited April 5, 2006 by Johnny Coli

[KRC]

UPDATE:

 

I found a committee summary of the report.

Link

UPDATE II:

Here's the Globe article on the lobbying and the interest groups behind it.

Lobbyists took in $7.5m on health bill

653150[/snapback]

OK, I did a quick scan and my concerns have been reinforced, namely with the people who can afford insurance but decide to go without insurance. From the link you provided:

 

The Department of Revenue will enforce this provision with financial penalties beginning with a loss of the personal exemption for tax year 2007 and then increasing to a portion of what an individual would have paid toward an affordable premium for subsequent years. {emphasis added}

 

Later in the link:

 

The Department of Revenue will enforce this provision with financial penalties. For tax year 2007, the penalty for not having health insurance coverage will amount to a loss of personal exemption. For tax year 2008 and later, the penalty will increase to a portion of what an individual would have paid toward an affordable premium. {emphasis added}

 

What this is telling me is that it is cheaper to ignore the system and just pay the penalties than it is to get insurance.

 

 

Other concerns:

Free Rider Surcharge

...imposition of the surcharge will be triggered when an employee received free care more than three times, or a company has five or more instances of employees receiving free care in a year. The surcharge will range from 10% to 100% of the state's costs of services.

 

Now, companies need to stick their noses into your personal lives? If not, they will be penalized?

 

 

Reduction of Racial and Ethnic Health Disparities

...requiring hospitals to collect and report on healthcare data related to race, ethnicity and language. Medicaid rate increases in th ebill are made contingent upon providers meeting performance benchmarks, including in the area of reducing racial and ethnic disparities.

 

OK, this can get scary. Without a better definition of how they are determining these "benchmarks" and how they are determining the disparities, it sounds like a quota. I need more information, but right now, I have a queasy feeling about this section.

[Johnny Coli]

OK, I did a quick scan and my concerns have been reinforced, namely with the people who can afford insurance but decide to go without insurance. From the link you provided:

Later in the link:

What this is telling me is that it is cheaper to ignore the system and just pay the penalties than it is to get insurance.

Other concerns:

Now, companies need to stick their noses into your personal lives? If not, they will be penalized?

OK, this can get scary. Without a better definition of how they are determining these "benchmarks" and how they are determining the disparities, it sounds like a quota. I need more information, but right now, I have a queasy feeling about this section.

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For the penalty portion:

I think you would have to look at the main body of the bill. Last night, the people who looked over the Bill all said that the penalties would be huge in the long run for people who didn't pay for a plan. You automatically lose your exemption, which can get substantial in this state, in adition to the other penalties which could end up being sveral thousands of dollars on top of that. We'll have to see on that one.

 

For the employer part:

The employers wouldn't track it, the hospitals would. It says that if an uninsured employee seeks care 3 times in a 12 month period, or there are 5 instances of your employees seekeing care, than you pay a surcharge. There is no surcharge if you offer a healthcare plan for your employees, and I imagine that if you do, and they don't buy into it, the employer is exempt and the employee eventually pays.

 

 

It is my understanding that the benchmarks are yet to be determined. I believe this is more of a requirement for providers in order to get the Medicare subsidy.

Health legislation puts emphasis on pay for performance

Many private health insurers and the federal Medicare program already pay providers bonuses for improving the care of patients with conditions such as diabetes or heart failure, and keeping them out of hospitals. They also pay more when providers hold down costs such as limiting the use of expensive imaging tests such as MRIs.

 

The Massachusetts bill adds a new aspect to pay-for-performance. In addition to improving quality, hospitals and doctors must show they are reducing racial and ethnic disparities in the delivery of healthcare and outcomes for patients.

[KRC]

For the penalty portion:

I think you would have to look at the main body of the bill.  Last night, the people who looked over the Bill all said that the penalties would be huge in the long run for people who didn't pay for a plan.  You automatically lose your exemption, which can get substantial in this state, in adition to the other penalties which could end up being sveral thousands of dollars on top of that.  We'll have to see on that one.

 

We will have to see on that one, because the summary you provided specifically states that it will be less (and states it twice that it will be less). The summary specifically states that it is cheaper to pay the fines than it is to by the insurance.

 

 

 

For the employer part:

The employers wouldn't track it, the hospitals would. 

 

If you are an employer, there is no question that you would track it as well, to prevent your company from getting a suprise (possibly substantial) financial hit. It just makes good business sense. Sucks for the employee, though.

 

 

There is no surcharge if you offer a healthcare plan for your employees, and I imagine that if you do, and they don't buy into it, the employer is exempt and the employee eventually pays.

 

I would need confirmation on that. Otherwise, it is a MAJOR drawback for small companies and you will see them running to adjacent states to open shop.

 

 

It is my understanding that the benchmarks are yet to be determined.  I believe this is more of a requirement for providers in order to get the Medicare subsidy.

Health legislation puts emphasis on pay for performance

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I figured that it would fall on the providers, but I would want to know the benchmarks and how things are determined. Say, for example, that it is a quota. You need to show that you are providing services equally to all races. On the surface, that is a good idea. The problem comes in when you try to impliment that policy. Do you need to start adding unnecessary tests for certain ethnicities in order to pad your numbers, because your demographics are not equal among ethnicities? For example, you are located in a predominantly Latino neighborhood. Your numbers are obviously going to be skewed to Latinos. If an African-American requires your services, do you need to add tests to make up for the fact that not as many African-Americans are using your services, just so it looks like you are providing equal services to Latinos and African-Americans?

 

 

 

 

On a completely separate note, I noticed that Kennedy's name is listed as helping, but Kerry's name is suprisingly absent? Not good for someone who wants to run for President again.

[mead107]

what will it cost in 5 years or 10 years . the little guy takes it right up the ass one more time .

[Live&DieBillsFootball]

Who knows if it will work, but I give Mass. credit for trying to do something about the problem of the underinsured. It looks like they were able to get a bipartisan consensus by putting personal responsibility into the equation instead of just another entitlement.

 

Obviously a more palatable path to Universal coverage than just expanding Medicaid to cover the uninsured.

 

Hopefully, this will lead to lower health care costs for companies and individuals as health care providers will no longer be spending lots of money on free care to the uninsured.

[Crap Throwing Monkey]

For the employer part:

The employers wouldn't track it, the hospitals would.  It says that if an uninsured employee seeks care 3 times in a 12 month period, or there are 5 instances of your employees seekeing care, than you pay a surcharge.  There is no surcharge if you offer a healthcare plan for your employees, and I imagine that if you do, and they don't buy into it, the employer is exempt and the employee eventually pays.

653191[/snapback]

 

That doesn't make it much more palatable. There's some very ugly HIPAA issues wrapped up in that. Very ugly.

 

And if there's no legal protections that prohibit companies from firing uninsured employees who seek medical care, it'll get even uglier.

[KRC]

And if there's no legal protections that prohibit companies from firing uninsured employees who seek medical care, it'll get even uglier.

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I didn't even think about that. With the sizable penalties that companies will face if their employees use "free" care, then it makes sense to get rid of people who opt out of paying for insurance.

[mead107]

Who knows if it will work, but I give Mass. credit for trying to do something about the problem of the underinsured.  It looks like they were able to get a bipartisan consensus by putting personal responsibility into the equation instead of just another entitlement.

 

Obviously a more palatable path to Universal coverage than just expanding Medicaid to cover the uninsured.

 

Hopefully, this will lead to lower health care costs for companies and individuals as health care providers will no longer be spending lots of money on free care to the uninsured.

653230[/snapback]

more profits for the big rich insurance company. they will never give back all they save .

[Crap Throwing Monkey]

I didn't even think about that. With the sizable penalties that companies will face if their employees use "free" care, then it makes sense to get rid of people who opt out of paying for insurance.

653278[/snapback]

 

I thought about that...because if I needed care for bipolar disorder, and I ran the considerable risk of my employer finding out about it and firing me, I probably wouldn't seek care. (And yeah, I know about the ADA. I've invoked it against a previous employer. Didn't stop them.)

 

Which is certainly one way to keep costs down...but not, I think, what Massachusetts had in mind.

[Chilly]

I thought about that...because if I needed care for bipolar disorder, and I ran the considerable risk of my employer finding out about it and firing me, I probably wouldn't seek care.  (And yeah, I know about the ADA.  I've invoked it against a previous employer.  Didn't stop them.)

 

Which is certainly one way to keep costs down...but not, I think, what Massachusetts had in mind.

653295[/snapback]

 

They fired you for that?

 

What pricks.

[Johnny Coli]

I didn't even think about that. With the sizable penalties that companies will face if their employees use "free" care, then it makes sense to get rid of people who opt out of paying for insurance.

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Well, that would be a pretty rare scenario. Companies that have 11 employees or more are required to offer insurance. The only people who qualify for free health care are people who make less than $9600/year, and the employer is exempt for the first $50,000 of the surcharge for each employee. I don't see that one being a problem, really. You could make a case that this part of the bill screws over companies with 10 or fewer employees who make less than $9600/year, but if that's how little they're paying their employees fug them.

[KRC]

Well, that would be a pretty rare scenario.  Companies that have 11 employees or more are required to offer insurance.  The only people who qualify for free health care are people who make less than $9600/year, and the employer is exempt for the first $50,000 of the surcharge for each employee. I don't see that one being a problem, really.  You could make a case that this part of the bill screws over companies with 10 or fewer employees who make less than $9600/year, but if that's how little they're paying their employees fug them.

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It does not take much to rack up $50K in hospital costs. My father-in-law was in the hospital recently and racked up some pretty good charges in a short amount of time.

 

As you mentioned previously, there needs to be protection for companies who offer insurance but the employees refuse it.

 

 

 

BTW, people are still waiting for your AI review. Stop talking about frivilous things like healthcare and get to it!!

[GG]

They fired you for that?

 

What pricks.

653316[/snapback]

 

 

They fired the Monkey. They kept DC Tom, though.

[Gavin in Va Beach]

National Health Care, great idea that...

 

http://www.timesonline.co.uk/article/0,,2-2122800,00.html

 

PATIENTS are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt.

 

Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs’ rights to refer people to consultants. 

 

The documents reveal that health trusts across London have drawn up plans to establish panels that will “monitor” how many patients are referred to hospital by GPs. Local health trusts have been told that they must cut GP referral rates to those of the lowest 10 per cent nationally. This, the document claims, would save £25 million a year in the capital.