Universal Health Coverage in MA

[firewhen]

Excite News - Deadline Near for Mass. Health Insurance

Let's hope this works. At the bottom of the article is a link to the coverage site. While coverage is not cheap if you are buying it yourself, for about $1,200 per month, a family can have coverage, including prescriptions, with minimal deductibles and copays. I certainly cannot get that now where we live, and is part of the reason I am still working, or at least feel the need to.

I hope that through efforts like this and the 2008 elections, something will finally happen nationally.

 

[ziggy29]

$1,200 a month is still a deal-breaker for a lot of people. That's more than a lot of people would pay for a Cadillac policy under COBRA.

How much for one with reasonable copays and deductibles?

 

[Hillbilly]

I certainly cannot get that now where we live, and is part of the reason I am still working, or at least feel the need to.

I hope that through efforts like this and the 2008 elections, something will finally happen nationally.

For what it is worth, I'm looking to move to an adjacent state that provides access to health care insurance (aka asset protection, guarantee issue state). I've waited long enough for my state to change their approach on health care and what they have to offer but it is time to move forward. Life is too short to wait on others. Set a time limit, have many health care options (I have nine) and set milestone dates to move forward with each. Don't let this issue paint you into a corner.

Hillbilly

 

[mykidslovedogs]

It'll be interesting to see how it pans out. Mitt has very good intentions. They're going to have to hold strong on penalties for the "irresponsibly uninsured" (people who can afford it but choose not to buy), otherwise, there will be problems. I predict that the plan is going to end up costing a lot more than what is currently budgeted...we'll have to wait and see. If they can get everyone insured, it might work!

It's interesting to me that 49% of the people polled felt they shouldn't be forced to buy coverage, yet 80% of people, according to other polls want universal care. I guess that means that 49% would rather be taxed than have the freedom to choose the kind of policy they want?

 

[Beststash]

It's interesting to me that 49% of the people polled felt they shouldn't be forced to buy coverage, yet 80% of people, according to other polls want universal care. I guess that means that 49% would rather be taxed than have the freedom to choose the kind of policy they want?

I think what they are saying is that people are frustrated with their choices - you can put lipstick on a pig.....I don't what something for free but I don't want the health industry to be able to cherry-pick whom and how individuals are covered with only profit as their motive.

Peace

 

[Hillbilly]

I think what they are saying is that people are frustrated with their choices - you can put lipstick on a pig.....I don't what something for free but I don't want the health industry to be able to cherry-pick whom and how individuals are covered with only profit as their motive.

Peace

Amen. If you have ever been on the "other side" of cherry picking, it is very frustrating .

 

[mykidslovedogs]

I think what they are saying is that people are frustrated with their choices - you can put lipstick on a pig.....I don't what something for free but I don't want the health industry to be able to cherry-pick whom and how individuals are covered with only profit as their motive.

Peace

But I think Mass is going to make the individual plans be guaranteed issue, so they shouldn't have any probs with cherry picking now.

 

[TromboneAl]

From what I can understand from the links, health insurance would be free for me if I lived in Massachusetts, since our income is less than $20,000 per year. Is that how it would work for retirees who are living off their after-tax assets?

 

[FinanceGeek]

points from the article...

[FONT=Verdana,Sans-serif][FONT=Verdana,Sans-serif] The law divides the population into three segments...[/FONT]

[FONT=Verdana,Sans-serif]This is all good, the whole point was to guarantee universal access and they're going to get this done pretty easily.[/FONT]


[FONT=Verdana,Sans-serif] Now, Cassidy said, they spend about $969 a month with a policy purchased through the Connector, a $250 savings. "That's grocery money," she said. "But I still haven't had to use it yet. It hasn't been put to the test."
[/FONT]

$969/month = Grocery money? Golly WHAT DO YOU EAT? I'd agree that the $250 savings / month is more akin to grocery money. Maybe MA has high priced produce?


Companies with 11 or more workers must offer insurance or face annual fees of $295 per worker.

I predict that virtually all companies in MA will drop health care coverage as a benefit to workers given that there is now a huge incentive to do so, e.g. the "fine" is much less than the cost of offering coverage.


[FONT=Verdana,Sans-serif]"There will be glitches in it and there will be gaffes at some point, but if we waited until every one of those things were nailed down, this would never get off the ground," Kirwan said.[/FONT]


[FONT=Verdana,Sans-serif]Absolutely agree, beware the law of unintended consequences. It takes guts to innovate and causes huge short term disruption to the status quo and those who benefit from it. Hooray to MA for at least trying, even if we all know upfront they won't get it all right anytime soon.l
[/FONT]
[/FONT]

 

[FinanceGeek]

the most important vote...

For what it is worth, I'm looking to move to an adjacent state that provides access to health care insurance (aka asset protection, guarantee issue state). I've waited long enough for my state to change their approach on health care and what they have to offer but it is time to move forward. Life is too short to wait on others. Set a time limit, have many health care options (I have nine) and set milestone dates to move forward with each. Don't let this issue paint you into a corner.

Hillbilly

...is when you vote with your feet!!!

I suspect Mass will see some of that happening too, basically in the long term you really cannot force people to do something they really don't want to. If the new MA system causes some people enough financial or mental heartache they'll simply move to an alternate locale.

Here's what I wonder about, will people with pre-existing conditions be forced into buying insurance at some absurd rate, e.g. $10k / month, per this mandate? Given that perhaps 10% of the population is "uninsurable" this could get quite nasty and result in some major relocation.

 

[cute fuzzy bunny]

$1,200 a month is still a deal-breaker for a lot of people. That's more than a lot of people would pay for a Cadillac policy under COBRA.

How much for one with reasonable copays and deductibles?

$1340 for a cobra blue cross policy with a $1500 deductible and 80% coverage after that, plus $25 office copays, $20 drug copays, etc.

Not so cadillacish...

About the same price for a similar BC/BS plan under californias high risk pool, and IIRC you only get to use that for 3 years.

 

[mykidslovedogs]

cute - What would you consider to be Cadillac? I would call a $1500 deductible copay plan a "cadillac plan". Remember, the 80% coverage after the deductible will be capped at a certain max out of pocket and then coverage will kick in at 100% thereafter. I think that's a GREAT deal. Heck, one MRI could use up that deductible, and that's not cadillac to you? A claim for $100,000 would leave someone on that plan with a max out of pocket of about $2500-3000. That's not bad at all.

 

[mykidslovedogs]

[FONT=Verdana,Sans-serif][FONT=Verdana,Sans-serif][/FONT]
Companies with 11 or more workers must offer insurance or face annual fees of $295 per worker.

I predict that virtually all companies in MA will drop health care coverage as a benefit to workers given that there is now a huge incentive to do so, e.g. the "fine" is much less than the cost of offering coverage.
[/FONT]

Finance Geek...you are right - Employers with more than 11 workers will start dropping benefits.

 

[FinanceGeek]

the whole point of insurance...

cute - What would you consider to be Cadillac? I would call a $1500 deductible copay plan a "cadillac plan". Remember, the 80% coverage after the deductible will be capped at a certain max out of pocket and then coverage will kick in at 100% thereafter. I think that's a GREAT deal. Heck, one MRI could use up that deductible, and that's not cadillac to you? A claim for $100,000 would leave someone on that plan with a max out of pocket of about $2500-3000. That's not bad at all.

MyKidsLoveDogs nailed it, this is not sounding bad to me either.

Does anybody recall that the entire point of insurance is to compensate for catastrophic losses, not to reimburse routine expenses?

 

[cute fuzzy bunny]

Hmmm...compared to my $800 plan with a $25 co pay, no deductibles, no out of pocket costs, 100% coverage plan with 90 day drug supplies for $20-40, that bc/bs plan seems very kia-ish...although at nearly twice the cost I guess it should come with a cadillac nameplate...maybe "cimmaron"...?

 

[mykidslovedogs]

Hmmm...compared to my $800 plan with a $25 co pay, no deductibles, no out of pocket costs, 100% coverage plan with 90 day drug supplies for $20-40, that bc/bs plan seems very kia-ish...although at nearly twice the cost I guess it should come with a cadillac nameplate...maybe "cimmaron"...?

Isn't your $800 plan with Kaiser? Kaiser has a very limited network. ...And take a look at that per admission hospitalization fee...(usually somewhere between $250 and $1000 PER ADMISSION). The PPO COBRA plan wouldn't have a per admission hospitalization fee like Kaiser does. On the COBRA plan, the extra you are paying for is the huge national and even worldwide network, plus - no need to see a primary care doc for referrals. Didn't you say that $800 plan with Kaiser is an "individual" plan vs. employer-sponsored? Individual plans are NOT guaranteed issue like COBRA plans are, so that would be reason number two for the lower premiums, and reason number three? Individual plans don't cover maternity...that cost is built into the COBRA plan from the x-employer....which brings me to another issue....

If in Mass, employers start dropping their benefit plans, what are people going to do for maternity coverage since individual plans typically don't mandate maternity like employer-sponsored plans do? I'll bet the next step will be for the gov't to start mandating maternity coverage on the individual plans....which is going to add a lot to the cost..

Also, I can see a lot of small employers with just over 11 employees getting rid of just enough employees to get below that 11 person limit, which means an increase in unemployment, which means there will be a lot of people needing to get on those subsidized healthplans, which means that eventually, taxes will eventually have to go up to compensate for that.

 

[TromboneAl]

Am I correct in understanding that a high-net-worth early retiree with very low income would get free health insurance?

will people with pre-existing conditions be forced into buying insurance at some absurd rate, e.g. $10k / month, per this mandate?

It depends on what it means by "should be able to pay" in this chart:

 

[FinanceGeek]

MyKidsLoveDogs - yes yes yes many companies will stay under 11 employees if they can, including via attrition, use of contract employees, etc. I don't know if MA law allows companies to exclude pregnancy / childbirth like the Western states law does, but if so, I think we've just found the first "unintended consequence" of the MA law. Smells like a lot of adverse selection coming down the pike.

With respect to Kaiser and other HMOs it has always struck me as irrational that people choose them over PPO arrangements since they are MOST likely to deny you (or lack the ability to provide) the catastrophic and expensive high tech services that are the whole raison d'etat of health insurance. I'm sure they do great with soccer injuries, perhaps better than other models, but they have an enormous incentive towards cost containment that leads to a large number of scary incentives contrary to my health and welfare.

TromboneAl - I've often wondered why more early retirees don't think in terms of tapping their asset base via loans and other mechanisms with an view of avoidance of realizing taxable income. If we arrive at a healthcare system which creates sufficient incentives to have a low taxable income you can bet your bippee it'll start happening. One might even increase one's asset allocation to favor zero coupon munis in anticipation of some delicious capital gains from increased future demand

What a VERY bright group of people on this forum!

 

[maddythebeagle]

TromboneAl - I've often wondered why more early retirees don't think in terms of tapping their asset base via loans and other mechanisms with an view of avoidance of realizing taxable income. If we arrive at a healthcare system which creates sufficient incentives to have a low taxable income you can bet your bippee it'll start happening. One might even increase one's asset allocation to favor zero coupon munis in anticipation of some delicious capital gains from increased future demand

What a VERY bright group of people on this forum!

My state's high risk pool also has subsidies for the income less than 25k/year and pay less for each 5k step less than that...no mention of assets.... Although the catch is that folks with income more than 25k can take plans with higher deductibles and end up with LOWER premiums than folks with lower income....

---------but hey, we all know here that 20k in investment income (with little in taxes), no cost health insurance, and paid off house is living high off the hog....but how much is property taxes in boston, 20k/year

 

[farmerEd]

[FONT=Verdana,Sans-serif][FONT=Verdana,Sans-serif][/FONT]
I predict that virtually all companies in MA will drop health care coverage as a benefit to workers given that there is now a huge incentive to do so, e.g. the "fine" is much less than the cost of offering coverage.
[/FONT]

Are you serious? If that was even remotely true, "virtually all" the companies in the state should then drop their hourly wage rate to $5.15/hour for all their employees....

 

[FinanceGeek]

Although many on this forum probably do not realize it, many to most countries outside of the first world have taxation systems where the primary input to the taxation equation is 'wealth' rather than 'income', due to endemic non/under reporting of incomes. Pray that such a system never graces our fair shores as it would readily enable the institution of health care premiums based on one's net worth as opposed to one's realized income.

Such a system would pretty much end the possibility of FIRE for anybody with a pre-existing health condition.

 

[farmerEd]

With respect to Kaiser and other HMOs it has always struck me as irrational that people choose them over PPO arrangements since they are MOST likely to deny you (or lack the ability to provide) the catastrophic and expensive high tech services that are the whole raison d'etat of health insurance. I'm sure they do great with soccer injuries, perhaps better than other models, but they have an enormous incentive towards cost containment that leads to a large number of scary incentives contrary to my health and welfare.

The HMO model is not perfect, BUT as someone who's wife used to work for Kaiser (as an RN), the one thing they did try very hard to do, was keep you healthy...the healthier you were, they less they saw you, the more money they made....on the other hand, after Kaiser left Massachusetts, the DW stayed at the same doctors office (which became independent), and the modus operandi was to tell people they needed to come in to be seen by the doctor, no matter what the complaint on the phone was. The logic being of course, the only time the doctors made money, was when they saw patients...and the sicker they were, the more money they made...and the more tests they ordered the more money they made, and if the patient stayed sick for years, even more money was made...etc etc.

Big turning point for profitability for this practice was when they purchased a few sigmoid machines to do colonoscopies instead of sending them to a specialist...apparently they are very profitable...so now all the patients are taking it up the @ss and the doctors make even more money... (true story).

 

[FinanceGeek]

I stick by what I predicted...

Are you serious? If that was even remotely true, "virtually all" the companies in the state should then drop their hourly wage rate to $5.15/hour for all their employees....

My comment references the newly created mandate that virtually all employers in MA must either provide health care coverage to their workers or pay a fine/fee for not doing so.

In most service industry jobs the work and the workers are both commodities, e.g. it isn't necessary to offer high wages or comprehensive benefits to attract workers with sufficient skills to do the job. Companies in MA just got a HUGE break out of this new law that they can suddenly shift the health care costs to their workers rather than being forced to offer health care coverage themselves. Do you really think that for businesses paying people $8 to $12 an hour it would be cheaper to offer BCBS health insurance as a benefit or instead pay the state $200 odd per year per employee. I'm thinking that $200 per MONTH might make that a more breakeven equation...

As to all businesses dropping the prevailing wage to legal minimum, I don't see that happening nor do I see it as a plausible conclusion to the point I made. Workers will receive the wage at which supply for their skills meets demand. MA is a high cost of living locale and I doubt very many people make the minimum wage now, nor do many jobs offer it. I am only pointing out that very few businesses are likely to offer health insurance to workers given this new program under which the workers can buy it themselves.

 

[farmerEd]

My comment references the newly created mandate that virtually all employers in MA must either provide health care coverage to their workers or pay a fine/fee for not doing so.

In most service industry jobs the work and the workers are both commodities, e.g. it isn't necessary to offer high wages or comprehensive benefits to attract workers with sufficient skills to do the job. Companies in MA just got a HUGE break out of this new law that they can suddenly shift the health care costs to their workers rather than being forced to offer health care coverage themselves. Do you really think that for businesses paying people $8 to $12 an hour it would be cheaper to offer BCBS health insurance as a benefit or instead pay the state $200 odd per year per employee. I'm thinking that $200 per MONTH might make that a more breakeven equation...

As to all businesses dropping the prevailing wage to legal minimum, I don't see that happening nor do I see it as a plausible conclusion to the point I made. Workers will receive the wage at which supply for their skills meets demand. MA is a high cost of living locale and I doubt very many people make the minimum wage now, nor do many jobs offer it. I am only pointing out that very few businesses are likely to offer health insurance to workers given this new program under which the workers can buy it themselves.

But they already don't have to offer health insurance...why would the addition of a fine for not offering it make it more likely to not offer it? I don't get it....

 

[FinanceGeek]

sorry I wasn't clear...

But they already don't have to offer health insurance...why would the addition of a fine for not offering it make it more likely to not offer it? I don't get it....

One of the varied proposals floating around MA that led to this law would have forced all employers to offer health insurance to most/all employees, with no provision for paying a low fee to avoid it. Obviously if something like this had been enacted businesses would get hit with a much higher cost than the $200 or whatever per year that the final law provided for.