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Other than Massachusetts, any other States requiring ALL to have Health Insurance?
Old 11-27-2007, 08:41 AM   #1
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Other than Massachusetts, any other States requiring ALL to have Health Insurance?

I know that Massachusetts passed a law last year requiring each citizen to have health insurance. If you have pre-existing conditions, there are insurance companies to cover you in Massachusetts, so everyone is covered. Yes, the health insurance in Mass. is higher than the norm.
But are there any other States that have passed a law requiring all to be covered by health insurance? I caught a thread on a board that listed the following, but am not certain if the laws in these States have been passed yet: New York? Vermont? New Jersey? Maryland? Maine?
Anyone know on this board about this issue?
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Old 11-27-2007, 09:01 AM   #2
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Required coverage? None that I know of aside from MA. But some states (like NJ) do not allow insurers to reject anyone who applies for coverage.
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Old 11-27-2007, 09:03 AM   #3
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New Jersey, New York, Vermont, Maine and Mass do not allow insurers reject applicants.

I haven't been keeping up lately, but I do not believe any states other than Mass have passed a law requiring health insurance. One way to keep up is to subscribe to this blog: The Health Care Blog
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Old 11-27-2007, 09:29 AM   #4
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Thanks for the info. I like that policy myself. Better than Illinois where I am that had the insurance people biting their nails wondering if I would pass their rigid background checks (I did) and who repeatedly refused to believe me (yes!) when I told them that I had really never been sick (a C-section is not sick as that's pregnant; tonsils out at 6; and that's it). I think most of the Police State of Illinois sucks and cannot wait to leave here when my duty is done (I just had to add that comment).
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Old 11-27-2007, 09:32 AM   #5
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Yeah, it's all over the airways here ... "Insure before the deadline" (1 January). Rumor is you needed coverage by mid- November because of the waiting period (45 days?).

We have individual plan out of NH (BC/BS) ... tried to get a quote using a MA address to see if the costs were better. Got to the end and was told "A sales agent will call"; not what I wanted. Will try another web site. Heard the state is subsidizing anyone under 45k/year ... have to look at my last couple tax returns.
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Old 11-27-2007, 10:41 AM   #6
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Originally Posted by Orchidflower View Post
I know that Massachusetts passed a law last year requiring each citizen to have health insurance. ...
Besides the requirement that insurance companies must cover applicants, what problem does the Mass. law solve and how? (I don't mean this rhetorically.)

Isn't one of the presidential candidates proposing the same thing on a national level? (H. Clinton?)

Auto liability insurance is required to drive in my state, but thousands of deadbeats still drive without insurance or even licenses.

Won't the same thing happen if there was a law mandating health insurance? Some large number of people wouldn't buy health insurance and would continue to use the emergency rooms and/or fail to pay doctor bills.

Our problem is the high cost of medical insurance. It sounds like the Mass law pushes the price even higher.
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Old 11-27-2007, 11:00 AM   #7
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Besides the requirement that insurance companies must cover applicants, what problem does the Mass. law solve and how? (I don't mean this rhetorically.)

Isn't one of the presidential candidates proposing the same thing on a national level? (H. Clinton?)

Auto liability insurance is required to drive in my state, but thousands of deadbeats still drive without insurance or even licenses.

Won't the same thing happen if there was a law mandating health insurance? Some large number of people wouldn't buy health insurance and would continue to use the emergency rooms and/or fail to pay doctor bills.

Our problem is the high cost of medical insurance. It sounds like the Mass law pushes the price even higher.
Being from Mass. I did some research as I might need this next year.

The way the program works is based on the # of dependents that you have and your income. As long as your income is less the 300% x's the poverty level you qaulify for masscare. If not you can get HealthNet, multple scaled option's. I have 5 dependents and as long as I make less then $72k/yr I qualify. The program entitles me to 4 networks all with the same level of service. Depending on your income level you can get dental as part of it(less the $25k/yr).

If you do not have health insurance by the deadline you will be fined when you submit your state income tax's.

Personally I think that the program is wonderful - alot of uninsured people now have insurance and are not a drain on the system - i.e. my premiums paying for them when they enter an emergency room. Sure their will alway's be a % of the population not insured but now people like my Barber & Gardener have insurance - when they could not afford it before.

In comparision to my current company plan I pay $1400/month for it vs. the same plan in HealthNet for $1200/month.
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Old 11-27-2007, 11:19 AM   #8
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...If you do not have health insurance by the deadline you will be fined when you submit your state income tax's.

Personally I think that the program is wonderful - alot of uninsured people now have insurance and are not a drain on the system - i.e. my premiums paying for them when they enter an emergency room...
In theory this may be nice and full of sunshine, but I wonder how long it will take for my health insurance premiums to go down. They've been going up double digits for years including a 15% increase in 2006 and an 18% increase in 2007.

And, how is the state going to enforce the penalty for not having health insurance? I don't see the mechanism that will make this work.
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Old 11-27-2007, 12:53 PM   #9
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When insurance companies are not allowed to reject someone, are they also not allowed to charge higher premiums for high risk people? How does that work?

And isn't universal health insurance supposed to cause rates to go down (bigger pool, less drain on healthcare)? Or does that only work on a national level?
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Old 11-27-2007, 01:13 PM   #10
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From my reading, Massachusetts health insurance rates WILL definitely be higher than other States now; however, for those people who have pre-existing conditions and are refused policies in Police States, like Illinois, it would be a smart move for them to relocate to Massachusetts, I would think, if they could afford to. Just my opinion.
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Old 11-27-2007, 01:20 PM   #11
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When insurance companies are not allowed to reject someone, are they also not allowed to charge higher premiums for high risk people? How does that work?

And isn't universal health insurance supposed to cause rates to go down (bigger pool, less drain on healthcare)? Or does that only work on a national level?

We will have to see. One problem that has occurred is that the older and the uninsurable have readily signed up for the program, but the younger and healthier have not. You need the young people who often go without insurance to sign up to. Unfortunately, many apparently have chosen to pay the penalty rather than buy insurance.

Will take some more playing out and probably some tinkering before we can draw too many conclusions.
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Old 11-27-2007, 01:26 PM   #12
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Besides the requirement that insurance companies must cover applicants, what problem does the Mass. law solve and how? (I don't mean this rhetorically.)

Isn't one of the presidential candidates proposing the same thing on a national level? (H. Clinton?)

Auto liability insurance is required to drive in my state, but thousands of deadbeats still drive without insurance or even licenses.

Won't the same thing happen if there was a law mandating health insurance? Some large number of people wouldn't buy health insurance and would continue to use the emergency rooms and/or fail to pay doctor bills.

Our problem is the high cost of medical insurance. It sounds like the Mass law pushes the price even higher.
The insurance companies will tell you one of the problems they have is young people do not pay premiums, driving up the costs for the older portion of population.

With auto insurance good drivers subsidize the costs for the reckless drivers which are accident prone.

Life insurance works a similar way- I pay premiums while young and this pays the benefit and reduces the risk of an old person dieing to insurance company.
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Old 11-28-2007, 07:32 AM   #13
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This morning I heard a report about the health ins here in MA. It seems they aren't having a problem getting people to sign up, they didn't give age groups but I'm betting it's the older people. The reporter also said that with so many signing up and the lagging economy that they are looking at a possible 200mil shortfall for the program.
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Old 11-28-2007, 07:47 AM   #14
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When insurance companies are not allowed to reject someone, are they also not allowed to charge higher premiums for high risk people? How does that work?

And isn't universal health insurance supposed to cause rates to go down (bigger pool, less drain on healthcare)? Or does that only work on a national level?
In NJ we have a system for the individual market that does not allow anyone to be rejected and companies basically cannot underwrite. Most of the population is covered under group (employer) policies or by medicare/medicaid, so the remaining people stuck in the individual market are faced with about three insurers to choose from and cripplingly high premiums for lousy coverage. There is a lot of negative selection in the NJ individual health market, which drives all of this. So if you are not forcing everyone into the system, this sort of thing does not work well.

I think it will be interesting to watch what happens in Mass. It might be a good model to follow.
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Old 11-29-2007, 09:50 AM   #15
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Auto liability insurance is required to drive in my state, but thousands of deadbeats still drive without insurance or even licenses.

Won't the same thing happen if there was a law mandating health insurance? Some large number of people wouldn't buy health insurance and would continue to use the emergency rooms and/or fail to pay doctor bills.
One of the problems I'm hearing with the current Massachusetts plan is that they are too successful in getting the poor uninsured to sign up for their free lunch, but not getting enough of the young and healthy individuals -- the kind whose participation makes the numbers work) -- as many of them are opting to pay the "fine" for not buying a policy rather than buy one. Perhaps they need to make the fine as costly as a health plan?

In other words -- surprise, surprise -- the people getting something for nothing (or nearly nothing) are signing up at unexpectedly high rates, while the people paying the freight are slow to embrace it.
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Old 11-29-2007, 10:09 AM   #16
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One of the problems I'm hearing with the current Massachusetts plan is that they are too successful in getting the poor uninsured to sign up for their free lunch, but not getting enough of the young and healthy individuals -- the kind whose participation makes the numbers work) -- as many of them are opting to pay the "fine" for not buying a policy rather than buy one. Perhaps they need to make the fine as costly as a health plan?

In other words -- surprise, surprise -- the people getting something for nothing (or nearly nothing) are signing up at unexpectedly high rates, while the people paying the freight are slow to embrace it.
Insurance of any kind is socialism at its best.

There is a shared amount of financial responsibility for sure.

My suggestion would be to lump life and health insurance into ONE product. One person sells them, you buy the product you want. Cash value/permanent insurance type products, with limitations on when cash value can be tapped.

A single person aged 18 could buy a discounted policy which paid 30k at death (funeral). This premium would also cover well visits to a hospital as well. Should be permanent insurance type of policy, so there is a cash value similar to an HSA.

single person ages 23 with a new job now wants more coverage-70k to cover debts (40k of students loans plus 30k funeral costs). If few claims were made on previous policy this rate is cheap, as cash value is built up.

married person aged 28 with family- needs more coverage, pays more into system.

etc...

Has it's issues, but it's better than waiting for young people to sign up- the key is we need to make this DIRT cheap for 18 year olds to sign up. Like $100/year or something.
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Old 11-30-2007, 08:07 PM   #17
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I've been watching the MA system with high hopes. I guess I don't understand how they can force people to buy insurance ... for one thing how do you track down all the people who don't file taxes (e.g. the unemployed, homeless, etc. who really need health insurance).

The so-called "fine" is apparently far less than the cost of a health insurance policy, as long as that's true I'd expect that many healthy people who do file taxes would simply view the fine as an additional tax that they have to pay and continue to go without insurance.

Such a system will still have plenty of adverse selection that will probably be its ultimate downfall.
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Old 11-30-2007, 08:17 PM   #18
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I've been watching the MA system with high hopes. I guess I don't understand how they can force people to buy insurance ... for one thing how do you track down all the people who don't file taxes (e.g. the unemployed, homeless, etc. who really need health insurance).

The so-called "fine" is apparently far less than the cost of a health insurance policy, as long as that's true I'd expect that many healthy people who do file taxes would simply view the fine as an additional tax that they have to pay and continue to go without insurance.

Such a system will still have plenty of adverse selection that will probably be its ultimate downfall.
As for the homeless and unemployed, they are easy to find when you create a program that gives them health insurance at little or no cost to them. In fact, the Massachusetts program has far exceeded their projections in terms of signing up the poor to receive free or subsidized insurance. The poor and homeless can be very easy to find when you are giving something away at little to no cost to them.

As far as the inadequate fine, it does seem that if one is going to make it mandatory to be insured with a fine being the punishment for not doing so, you need to make the fine at least as costly as the annual cost of purchasing a health plan. That would get the wealthier and healthier uninsured into the game.

As of now, you are absolutely right about the adverse selection; it seems that Massachusetts has overestimated the willingness of the healthy and affluent to play along and also underestimated the alacrity with which the poor who pay little or nothing signed up.

This is still very much a work in progress. What they do isn't worth emulating until we see what works and what doesn't, and whether they can make it work moving forward. It's possible they could be a blueprint for federal changes, but they aren't there yet.
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Old 12-01-2007, 09:43 AM   #19
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Ziggy you're still going to have adverse selection even if they had some gestapo-like way to force all breathing inhabitants of MA to sign up for health insurance.

You'll have it because the healthy folks who find the fees to be onerous enough will simply leave the commonwealth.
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Old 12-01-2007, 09:56 AM   #20
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Ziggy you're still going to have adverse selection even if they had some gestapo-like way to force all breathing inhabitants of MA to sign up for health insurance.

You'll have it because the healthy folks who can get insurance cheaper elsewhere will relocate out of the commonwealth.
Maybe yes, maybe no.

One adverse selection type problem is that a lot of the healthy people get insurance through work and so it is subsidized by employers.

But as far as people leaving the state, I question whether that will be a significant problem. People simply do not want to leave home. Heck, the poor and uninsured could move to Mass. (dang, I wish I could spell that state's name) to get insurance. But it doesn't happen. People tend to stay put. Maybe people in border communities might move for insurance reasons, but otherwise, I think it is rare.
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