So how is the Massachusetts reform going? My take: It is the best of times; it is the worst of times.
It’s not a surprise that of the mix of policy changes, some are working, others are not: A useful guide to see what we want to pick and choose here.
The best of times: The expansion of public programs there has enabled over 100,000 uninsured folks to get coverage, moving Massachusetts to have the lowest rate of uninsurance of any state in the country, alongside Hawaii and Minnesota. Appropriately, the help is greatest where the need is greatest, with low-income individuals and families. These sort of expansions of proven public programs are what work in our health system, and that’s why we support similar proposals here in California, to expand Medi-Cal and Healthy Families.
Let’s also remember context: MA was already 6th lowest uninsured before their reform. CA is on the other end of the spectrum, with the 5th highest uninsured. So we have a longer ways to go.
The worst of times: The idea that consumer advocates have been most alarmed about, the “individual mandate,” is raising alarms there, too, as they approach the July 1 date for its implementation. The problem is that for many, the coverage that is available is simply too expensive for those with middle-class incomes. Policymakers are trying deciding between an unaffordable premium, or an unaffordable benefit, one that either has too high cost-sharing or that doesn’t cover key services, like prescription drugs. And for that latter choice, what’s the point of having coverage if it doesn’t cover what you need, or is too expensive to use?
This debate is being well-documented by the MA consumer group, Health Care for All. Massachusetts does has an escape valve, stating that the individual mandate does not apply if coverage is “unaffordable,” so it is likely that some category of individuals above $30K/year or families of four over $60K/year–who won’t get subsidized coverage–will simply be exempt from the plan. (FYI, Governor Schwarzenegger’s individual mandate proposal does not include any exemption whatsoever.)
For these Massachusetts individuals that don’t have the benefit of employer based coverage (and the MA plan does virtually nothing to help them get it, and Governor Schwarzenegger’s plan won’t help most), the *best* case scenario is that they stay uninsured–and face the health and financial consequences of being uninsured. The *worst* case scenario is that they are forced to spend an unaffordably large percentage of their income to get stripped-down and/or high out-of-pocket cost coverage that will not be useful to them.
And that would be Dickensian, indeed.