Massachusetts Health Law: "We Have To Roll Up Our Sleeves"By Susan Bush
12:00AM / Saturday, April 15, 2006
North Adams - EcuHealth Care Executive Director Charles "Chip" Joffe-Halpern expects a busy year ahead.
The April 12 approval of the nation's first-ever state health care legislation, the Massachusetts Health Reform Bill, likely means a significant number of people will move from a volunteer physician free care pool overseen by the EcuHealth Care organization to one of the yet-to-be detailed healthcare programs promised by state leaders.
"A Huge Deal"
"I would say that 95 percent of people who are served by Ecu Care will be eligible for subsidies to help pay for health insurance," Joffe-Halpern said during an April 13 interview.
Gov. Mitt Romney signed the health care reform bill into law on April 12, but vetoed a Fair Share Assessment that would have forced businesses with 11 or more employees to either offer health insurance benefits or pay a $295 fee per employee.
However, he did not veto a provision that would financially penalize state residents who are not covered by employer-offered benefits and fail to sign up for one of the planned state-offered programs. Residents have until July 1, 2007 to enroll in some kind of health insurance plan and become compliant with the law.
Joffe-Halpern termed the health care coverage mandate a "huge deal," but stressed that the ultimate success of the law is incumbent on the state-devised plans being affordable and adequate.
No "Easy Button"
He believes that four state-governed plans will be crafted and offered to state residents, he said. The work will not be easy.
"I think what we have to do is roll up our sleeves and realize that, unlike the television commercial, there is no 'easy button,'" Joffe-Halpern said.
Under a state subsidized "Commonwealth Care Health Insurance" program included in the legislation, state residents should be able to pay premiums assessed on a sliding scale basis.
Folks whose incomes are less than 300 percent of the federal poverty will be eligible for commonwealth care coverage under the plan and those options will have no deductibles, according to Joffe-Halpern. The program will be available via another state generated entity, a "Commonwealth Health Care Connector."
According to Joffe-Halpern, single people who earn $29,400 or less annually, and a family of four that earns $60,000 or less annually would be eligible for the commonwealth care plans, under the current legislation. There are about 300,000 state residents who fall into that category, he said.
"If the plans can be developed and are affordable, this can be an amazing achievement, particularly in this political climate," he said.
According to the legislation, individuals who earn less than 100 percent of the federal poverty guideline, or $9,600 a year or less, protections are in place to offer insurance coverage with comprehensive benefits.
Under those plans, premiums would be waived for those who meet the income guidelines.
Financial Issues Likely After Three Years, Says McDonough
A "Healthy Blog" hosted by the state-based non-profit organization Health Care For All's Executive Director John McDonough acknowledged financial challenges ahead for the legislation.
"Year three..fiscal 2009..shows a deficit of $167 million; this is balanced by surpluses in the first two years, providing a balanced spending plan for the first three years," McDonough wrote. "Beyond that, significant issues."
By The Numbers
McDonough also posted what he believes to be accurate financial information about the legislation's cost on April 9:
**********Sources*****FY 07 FY 08 FY 09
Federal Safety Net Revenue: 605.0 610.5 610.5
Federal Medicaid Match: 184.6 242.1 299.6
Hospital Assessment: 160.0 160.0 160.0
Payor Assessment: 160.0 160.0 160.0
Free Rider Surcharge: 50.0 40.0 25.0
Fair Share Assessment: 45.0 36.0 22.5
General Fund: 125.0 125.0 125.0
MCO Supplemental Funding 287.0 180.0 160.0
Free Care Pool/Safety New Fund: 610.0 500.0 320.0
SubTotal: 897.0 680.0 480.0
Children to 300%: 18.2 27.4 37.4
Restored MassHealth Benefits: 48.0 53.0 58.0
Medicaid Rate Increase: 90.0 180.0 270.0
Commonwealth Care Subsidies: 160.0 400..0 725.0
Subtotal: 336.2 660.0 1090.4
**************FY 07 FY 08 FY 09
Total Spending: 1,233.2 1,340.0 1,570.4
Three Year Balance +116.4 +33.2 -167.9
"Up To Us To Hold Them To It"
McDonough then queried "how does this hold up?"
"Our sense - passes the laugh test, plausible and tight," he wrote. "Likely to turn out as planned? Not likely. Prepare for surprises, pleasant and unpleasant. That's life in this territory. What's important now--strong commitment by House and senate leaders to make it work--real political commitment to meet the promises outlined in the soon-to-be new law."
McDonough's April 9 post concluded with what may be at the core of the now existing legislation.
"Up to all of us to hold them to it."
For more information about Health Care For All: www.hcfma.org
For McDonough's blog: www.hcfama.org/blog
Susan Bush may be reached via e-mail at firstname.lastname@example.org or at 802-823-9367.