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Patrick to unveil recommendations for lower-cost health plans

BOSTON --Gov. Deval Patrick was scheduled Saturday to unveil key reoommendations in the state's quest for lower-cost insurance plans mandated by the state's new health care law.

"After weeks of negotiations with health insurance companies, we been able to arrive at a number and cost of health insurance coverage that we think is both affordable and maintains quality," Patrick spokeswoman Cyndi Roy said.

The plans are a critical piece of the landmark insurance initiative, designed to require health coverage for all Massachusetts residents by July.

One of the toughest parts of the law has been trying to come up with relatively low cost private health plans for uninsured residents earning too much to qualify for subsidized care -- about $29,400 annually for an individual.

But coming up with a definition of what the state considers minimal coverage has proven elusive. The definition is crucial, since only plans that meet the guidelines will receive the state's blessing and exempt those who enroll in them from possible tax penalties.

As the law was being unveiled last year, former Gov. Mitt Romney said the goal was to get monthly premiums as close to $200 a month as possible.

That hit a snag when insurers warned that without more freedom to offer plans that would drive down premiums by reducing coverage, the monthly premiums could creep closer to $380 a month.

Those estimates have dropped after the companies were told to go back to the drawing board, Roy said.

"The bids they submitted are significantly better than what was reported in weeks prior," she said.

Another thorny question is whether the lower-cost private plans should be required to include prescription drug coverage.

Insurers say drug coverage should be optional, not required. They say at least 210,000 Massachusetts residents already have insurance plans that offer very limited or no drug coverage.

Health care advocates say any minimum coverage must include prescription coverage. They say that without it, the state would be giving its blessing to inferior insurance plans.

Last month, over the objections of some it own board members, the panel charged with overseeing the law -- the Commonwealth Health Insurance Connector board -- asked insurers to provide prices for low-cost insurance plans that don't include prescription drug coverage.

Board members said they wanted to compare the prices to the cost of those same plans once prescription drug coverage was added back in.

Patrick was scheduled to unveil recommendations on the lower-cost plans at a Statehouse press conference with Commonwealth Health Insurance Connector Authority Executive Director Jon Kingsdale and Patrick's budget chief Leslie Kirwan, who heads the health care board.

The board must still approve the recommendations.

Under the new health care law, all residents are required to have health insurance by July 1 or face tax penalties. An estimated 160,000 to 200,000 people are uninsured and do not qualify for state-subsidized plans.

The plans would still have to meet other requirements, including creating a maximum deductible of $2,000 for individuals and $4,000 for families, covering at least three doctor visits for individuals and six for families, and capping maximum out-of-pocket spending for in-network services at $5,000 for individuals and $10,000 for families.

Policies with lifetime or annual maximums -- or maximum benefits per illness or injury -- would be banned. Plans that fail to meet the standards would be denied the board's approval.