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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
Week of: October 7
Week of: September 9
Week of: September 2

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Thursday, October 11, 2007

Cheaper drug plan stumps board

By Alice Dembner, Globe Staff

Massachusetts made history last March by requiring all residents to obtain health insurance that includes coverage of prescription drugs. Now, it's finding that making such coverage affordable is an even more heroic task.

The goal is to ease the sticker shock for more than 160,000 people who currently have health insurance that doesn't cover drugs and will have to upgrade their coverage by January 2009 when the drug requirement takes effect. In addition, about 30 percent of people who bought non-subsidized insurance through the connector this year have chosen coverage that excludes prescription drugs.

Today, members of the board overseeing the insurance requirement rejected a proposal that could have cut insurance premiums a few dollars a month by imposing a $1,000 deductible for any non-generic drugs.

Although the board of the Commonwealth Health Insurance Connector did not formally vote on the proposal, several members noted that it offered little savings on the monthly premium while potentially leaving people without adequate coverage.

“A deductible of $1,000 is pretty extreme,” said Celia Wcislo, a board member and assistant division director of labor union 1199 SEIU. “It’s a catastrophic plan; it doesn’t solve the problem.”

The board directed its staff to look for other ways to cut costs of prescription drug coverage, but the board is running out of time. Individuals buying insurance through employers may have to make adjustments in their coverage as early as January 2008 to meet the requirement for January 2009. And health insurers must still design actual policies that meet the new standard. The connector has set a November deadline to tell insurers what kind of coverage will meet state standards.

Typically, drug coverage adds at least 15 percent to a monthly insurance premium, or about $50 for a 37-year-old, according to the connector staff. The board is seeking to trim that to as low as 5 percent, or about $15, while still providing adequate coverage and allowing easy access to generic drugs.

“I’m concerned about people who will not only face double-digit premium increases when they renew their insurance, but additional costs to pay for drug coverage,” said board member Richard Lord, president of Associated Industries of Massachusetts.

In March, when the connector approved minimum standards for insurance, it allowed drug coverage with a deductible up to $250 for an individual. That is in addition to a deductible of up to $2,000 for medical care.

Two insurance plans currently offered through the connector’s Commonwealth Choice unsubsidized program include drug coverage with deductibles of $100 or $250. That coverage adds about $20 a month to the cost of insurance for a 37-year-old Boston resident. But four other insurers offering plans through the connector chose not to impose drug deductibles and added prescription coverage that costs from $32 to $40 a month. Most insurers also offer plans that provide more comprehensive drug coverage at a higher price.

Connector staff presented a proposal today for a drug plan that would cover all generic drugs for a copayment of about $15 a refill. But that plan would include a $1,000 deductible on all non-generic drugs, along with additional copayments of $50 or $75 per refill. The premiums would be nearly double for a 60-year-old.

The plan does not cover some expensive drugs at all, particularly when there are less expensive alternatives.

Coverage with that kind of separate deductible for drugs has not been popular in Massachusetts, and no insurer currently offers a plan with different deductibles for generic and brand drugs. But some suggested that it might appeal to people seeking the cheapest plan possible.

“They may prefer catastrophic coverage at a low premium,” said Ben Haas, a consultant hired by the staff to help prepare the proposal.

Robert Carey, director of planning and development for the connector, also suggested the alternative “would provide most people with a better benefit for lower cost" because generic drugs would not be subject to the deductible.

While some board members argued for providing people with this choice, others said employers might offer their staff only the $1,000 drug deductible plan, forcing employees to buy it or forfeit any employer subsidy.

“We could be compelling some people to purchase this…including people who don’t take generics or people who have serious medical problems,” said board member Nancy Turnbull, an associate dean at the Harvard School of Public Health.

Posted by Karen Weintraub at 06:55 PM

« New member joins Connector board | Main | Cheaper drug plan stumps board »

Insuring more people: good news and bad news

By Alice Dembner, Globe Staff

Another 12,000 people signed up for state-subsidized health insurance in September, pushing the total to 127,000, state officials said today. And the state this month is sending out notices to about 45,000 people it believes are eligible, but who haven’t yet enrolled.

Of the total enrolled, about 79,000 are getting full subsidies, far more than the 60,000 the state expected.

All that growth could put unexpected pressure on the state budget, a point made at today’s meeting of the Commonwealth Health Insurance Connector by board member Richard Lord, president of Associated Industries of Massachusetts.

Leslie Kirwan, chairman of the connector's board and state secretary of administration and finance, acknowledged that the state hadn’t budgeted for that success. “We’re still evaluating the impact,” she said.

Posted by Karen Weintraub at 06:50 PM

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New member joins Connector board

Alice Dembner, Globe Staff

The board of the Commonwealth Health Insurance Connector Authority is finally back up to speed with the appointment of Ian Duncan to fill the seat reserved for an insurance actuary.

Duncan, who runs a healthcare management consulting firm called Solucia in Farmington, Ct., attended his first meeting today and jumped right into a lively and complex discussion of a prescription drug benefit. The connector is overseeing implementation of the state’s new near-universal health insurance law.

Duncan replaces Bruce Butler, an actuary who resigned because of potential conflicts of interest between his private consulting business and the connector’s work.

State officials apparently had to reach out to Connecticut to find an actuary who didn’t have business connections with insurers working in Massachusetts.

In a 30-year career in healthcare management, Duncan has also worked for Aetna Life and Casualty and PricewaterhouseCoopers. He has recently specialized in evaluating disease management programs.

Posted by Karen Weintraub at 06:46 PM

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Friday, October 5, 2007

Who’s not offering health insurance?

By Alice Dembner, Globe Staff

In the first week of a 6-week filing period, only four Massachusetts companies fessed up to not providing health insurance for their full-time workers, according to figures from the administration of Governor Deval Patrick.

The state’s universal health insurance law requires companies with 11 or more employees to offer insurance or pay a fee of up to $295 per employee per year. To enforce this provision, companies must report by Nov. 15 whether they paid for insurance for at least one-quarter of their full-time workers or offered to pay at least one-third of an individual’s premium in the last year. Firms that don’t meet either of these tests must pay the fee.

From Monday through the end of business Thursday, about 860 companies with 11 or more employees filed. But only four said they would be subject to the fee. At least partial payment of the fee is due by Nov. 15.

State officials said they had no idea how many companies are required to file. But US Census figures from 2005 suggest there may be as many as 40,000 Massachusetts companies with 11 or more workers.

Posted by Karen Weintraub at 06:01 PM

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Thursday, September 20, 2007

Insuring the uninsured

By Alice Dembner, Globe Staff

Enrolling virtually every eligible uninsured person in the state’s subsidized insurance program is one of the goals the Commonwealth Health Insurance Connector today set for itself in the coming year.

As of Sept. 1, the total enrolled was just over 115,000.

The difficulty in meeting the new goal is that no one really knows how many state residents meet the income and other requirements for the Commonwealth Care program.
Last year’s estimates were between 140,000 and 210,000.

Another goal is signing up 35,000 people for the Commonwealth Choice program, which offers unsubsidized insurance including some stripped down plans, through the Connector.

This program is aimed at people with mid-level incomes or higher – and estimates suggested there were between 160,000 and 230,000 people without insurance last year in this income group.

The Connector is figuring that most of those people are going to get insurance through their jobs or directly from insurance brokers or companies.

Posted by Karen Weintraub at 03:13 PM

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Friday, September 14, 2007

Patrick blasts restrictions on children's health insurance

By Alice Dembner, Globe Staff

Restrictions imposed by the Bush administration on a program that provides health insurance for more than 90,000 children in Massachusetts are "dumb" and should be revoked by President Bush or overturned by Congress, Governor Deval Patrick said this morning.

Patrick said the new rules for the State Children's Health Insurance Program would deny health insurance to thousands of children and hurt the state's effort to provide coverage for all its residents.

"It's a step in the wrong direction and has to be prevented," Patrick said at a news conference at the Martha Eliot Health Center in Jamaica Plain.

At the same event, Senator John Kerry announced that he and Senator Edward M. Kennedy introduced legislation yesterday to overturn the new rules. Prospects for the legislation's passage are unclear, but Kerry pledged that "we are going to get these policies turned around."

Both the Senate and House last month passed bills to expand funding for SCHIP by billions of dollars, but Bush has threatened to veto the expansion.

The new rules are designed to restrict the program to families making up to 250 percent of the federal poverty level, but Massachusetts has extended coverage to those making up to 300 percent.

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Thursday, September 13, 2007

More get insurance

Another 10,000 people signed up for the state's subsidized insurance plan last month, bringing the total to 115,418, the Commonwealth Health Insurance Connector announced today.

The bulk of the enrollees in the Commonwealth Care program are getting full subsidies, but more than 22,000 are required to pay small premiums.

In addition, 7,164 people now have insurance through a separate, unsubsidized program, called Commonwealth Choice. Seventy percent of those people have chosen plans offered with lower than market premiums, most of which have coverage limits or high deductibles.

Posted by Elizabeth Cooney at 02:33 PM

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Monday, August 27, 2007

More state residents covered by insurance

By Liz Kowalczyk, Globe Staff

The number of Massachusetts residents without health insurance dropped to 355,000 this year, down from 395,000 last year, according to a newly-released state survey. The overall uninsured rate fell to 5.7 percent, from 6.4 percent.

Massachusetts officials said the drop indicates that the state's new mandatory insurance law is beginning to work.

"This is a clear indication that health reform is succeeding, '' said JudyAnn Bigby, state secretary of Health and Human Services. "Even in the early phase of the law's implementation, these findings confirm our success in reducing the number of uninsured people across the entire Commonwealth.''

The Center for Survey Research at UMass-Boston called 4,000 homes between January and June of this year.

Posted by Karen Weintraub at 04:49 PM

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Tuesday, August 14, 2007

On the blogs: Harvard hospital hiring, medical home

On Running a Hospital, Beth Israel Deaconess Medical Center CEO Paul Levy compares the participation of other Harvard teaching hospitals in the search for a new chief of OB/Gyn at his hospital to asking Toyota, Honda, General Motors and Chrysler to sit in on Ford's hiring process for a new division manager.

"What would be odd elsewhere is the norm here at the Harvard hospitals," he writes about the search to replace Dr. Benjamin Sachs, who is leaving to become dean at Tulane Medical School. "The Harvard medical system has an odd assortment of customs and norms. One of (the) oddities surrounds the search for a chief of any of the clinical departments at BIDMC, MGH, Brigham and Women's, Children's Hospital, and the other Harvard affiliates."

On WBUR's CommonHealth, Lynn Community Health Center's Lori Abrams Berry asks what happened to the idea of medical home as the state's new healthcare law gets implemented.

"No one should ever be auto-assigned away from an existing primary care relationship," she writes about people who did not choose a plan. "That is not what healthcare reform is all about."

Posted by Elizabeth Cooney at 02:04 PM

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Tuesday, August 7, 2007

More help for those seeking insurance

By Alice Dembner, Globe Staff

The Boston Public Health Commission today launched an effort to help the uninsured -- and particularly Latinos -- sign up for new health coverage.

Multilingual staff at the commission will be available all day Thursday at its 1010 Massachusetts Ave. offices to aid individuals and also to train healthcare providers in the enrollment process. In addition, the commission will host enrollment days from 9 to 11 every Wednesday this year at Boston Public School family resource centers in Roxbury, Roslindale, Dorchester and East Boston.

Barbara Ferrer, the commission’s new executive director, announced the initiative at the Dominican Festival in Jamaica Plain, saying in Spanish that she wants to “knock down any barriers that stand between residents and the doctor’s office.”

In Boston, fewer Latinos have insurance than any other ethnic or racial group, according to the commission.

Posted by Karen Weintraub at 04:36 PM

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Monday, August 6, 2007

Changing of the guard on health insurance board

By Alice Dembner, Globe Staff

Nancy Turnbull, an insurance expert who helped shape Massachusetts’ landmark health coverage initiative, is joining the board overseeing implementation of the experiment.

Attorney General Martha Coakley today appointed Turnbull to the unpaid board of the Commonwealth Health Insurance Connector.

Turnbull, who advocated for the full insurance coverage as president of the Blue Cross Blue Shield of Massachusetts Foundation, recently stepped down from that post to become an associate dean for educational programs at the Harvard School of Public Health.

“Nancy Turnbull is a leading advocate in Massachusetts health policy and she will be a powerful voice for consumers,” Coakley said in a statement.

Turnbull’s appointment on the 10-member board runs through June 2010. Coakley appoints three of the board's members.

“There’s a lot more to do,” Turnbull said in a phone interview. The issues she expects to focus on include outreach, affordability of coverage, and the long-term financing of the initiative.

Turnbull replaces Charles Joffe-Halpern, president of the board of the advocacy group Health Care for All, whose term on the Connector expired last month.

Joffe-Halpern, who is executive director of Edu-Health Care, which helps Berkshire residents gain access to health services, will serve Coakley as a member of a new health care advisory board.

Posted by Karen Weintraub at 05:08 PM

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Thursday, July 26, 2007

On the blogs: the new 'valley of death,' controlling healthcare costs

On Nature Network Boston, M. William Lensch, a scientist at Children's Hospital Boston and the Harvard Stem Cell Institute, writes a mournful entry about the gap created when researchers must depend on small foundation grants now that government funding of science -- which helps pay for a sponsoring institution's overhead -- is shrinking. It's a new version of the "valley of death" between academic research and commercialization of a discovery.

"With private grants ... you might be paying for all your own reagents but you are not paying your share for the bench space you have, the light shining down on it, or the salary of who sweeps the floor around it relative to someone with the same amount of grant support from the NIH," he writes. "Dig? Here’s where the Valley of Death comes in."

On WBUR's CommonHealth, John E. McDonough of Health Care For All outlines the predicament facing Massachusetts as it expands access to coverage while costs rise. He questions the objectives of the state Quality and Cost Council, created by the healthcare law.

"The set of goals embraces a popular hypothesis in health policy -- that if we just get quality right, given the documented amount of clinical waste in our system, that’s the magic pill to cure our cost disease. Wouldn’t it be luverly?" he writes. "What if this hypothesis is wrong? What if we do everything quality-wise and costs still rise at destructive, unsustainable rates? Are we willing to consider "R" word - regulation?"

Posted by Elizabeth Cooney at 12:11 PM

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Report questions affordability of health insurance reform

A report out today flags some of the big issues that could hamstring Massachusetts’ health insurance initiative – affordability, affordability, affordability.

The issue brief from the nonpartisan Center for Studying Health System Change is based on interviews with 25 observers – employers, state officials, insurers and advocates – done in January and updated in June.

The cost of insurance could keep both small employers and individuals from buying, the report asserts, leaving the results far short of universal coverage.

"Places like sandwich shops and auto repair companies are not embracing the reform," the report says, quoting an unnamed insurance broker.

In addition, rising costs could make the initiative unaffordable for the state, particularly if the economy sours, the report points out. And it questions whether the agency set up to implement the effort – the Commonwealth Health Insurance Connector – will add significant administrative costs to the total.

"At what point do the costs to the state getting one additional individual insured outweigh the benefits?" the report asks.

Posted by Karen Weintraub at 06:13 AM

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Tuesday, July 24, 2007

Primary care doctors in short supply, survey says

By Elizabeth Cooney, Globe Correspondent

Just when the new healthcare law in Massachusetts is expected to send more people to doctors’ offices, the state’s shortage of primary care physicians continues to be critical, according to a physician workforce study released today.

For the second year in a row, family practice and internal medicine doctors are harder to find, both for patients seeking appointments and for hospitals and group practices trying to recruit them, according to the sixth annual survey conducted by the Massachusetts Medical Society.

"Supply and demand are both going in the wrong direction," Dr. B. Dale Magee, the society’s president, said in an interview. "With the new healthcare reform law, we anticipate that the demand for physician services is going to increase, not only across the board, but especially for primary care physicians."

As of July 1, residents of Massachusetts were required to have health insurance. New coverage will mean new patient visits, health experts believe.

"We would anticipate in the earlier stages of the law that a disproportionate number of people with more advanced diseases will require care than later on," Magee said. "If you aren't seeing the doctor, you don't know you have high blood pressure or you may not know you have kidney disease. A lot comes to light with good preventive medicine."

Psychiatry also appeared on the list of critical shortages for the second year. Vascular surgery jumped to critical this year, up from its first ranking on the severe list last year.

Anesthesiology, cardiology, gastroenterology and neurosurgery are continuing a six-year trend of severe or critical shortages. Urology was added to the severe shortage list this year.

The study polled physicians, hospital presidents, residency and fellowship program directors, physician offices, and patients.

Internal medicine appointments are harder to get this year, the office survey found. A little over half (51 percent) are accepting new patients, down from 64 percent last year. The average time a new patient waits to see an internist with openings is 52 days, compared with 33 days last year.

Last year, 53 percent of patients reported they could see their primary care physician within a week of calling, but that fell to 42 percent this year.

Among hospitals, 68 percent of teaching hospitals and 83 percent of community hospitals are having trouble filling their physician vacancies. For 72 percent of community hospitals and 38 percent of teaching hospitals, that meant changing the provision of services.

Seventy percent of medical directors at group practices said the average amount of time to recruit a doctor had gone up over the last three years.

The medical society is trying to get state and federal government programs to consider some form of loan forgiveness for doctors who leave medical school deep in debt as a way to encourage them to choose the less lucrative primary care specialty, Magee said.

The society is also working with the American College of Physicians to bring more nurse practitioners and physician assistants into primary care offices to ease the crunch. Medical schools are being encouraged to highlight the need for primary care physicians. Fewer than 30 percent of medical school graduates in Massachusetts choose primary care, while 50 percent or more would be ideal, Magee said.

A separate Physician Practice Environment Index published by the medical society last year has shown a 13-year decline. Rising costs of doing business, including liability payments, and declining income account for much of the deterioration, the society said.

Today’s survey said that 86 percent of doctors believe that over the next five years their salaries will either decline or remain the same. About a quarter (24 percent) said they are planning or considering a move out of Massachusetts.

If given the chance, just over half (51 percent) said they would choose medicine again as their profession.

Posted by Elizabeth Cooney at 06:48 PM

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Monday, July 23, 2007

On the blogs: Joint Commission visit, euphemisms, privacy for immigrants

Surprise: On Running a Hospital, Paul Levy, president of Beth Israel Deaconess Medical Center, says the Joint Commission, which accredits hospitals, showed up this morning for an unannounced visit. Until last year, these periodic reviews of safety and quality were scheduled in advance, but now hospitals get no warning. The accrediting body, which used to be called the Joint Commission on Accreditation of Healthcare Organizations, will spend a week at the hospital.

"And, yes, we will publish our results once they go through the process of review at the Joint Commission headquarters," Levy writes.

Sugarcoating: On Healthy Children, Boston Medical Center pediatrician Dr. Steven Parker explores how doctors use euphemisms. Their intentions may be good, but they can end up creating confusion, he says.

"I know why this happens so often. Nice guys and compassionate to a fault, we pediatric providers hate to give bad news and avoid it when we can," he writes. "We think we are doing the family a favor: doesn't 'developmentally delayed' sound so much more hopeful, so much nicer, than 'mentally retarded?' "

HIPAA help: On WBUR's CommonHealth, Lori Abrams Berry of the Lynn Community Health Center worries that undocumented immigrants are being told that community health centers must report them to immigration officials if they seek health care.

"We need to find as many ways as we can to put the word out that community health centers are NOT obligated to report undocumented patients to immigration authorities," she writes. "On the contrary, HIPAA regulations actually prohibit us from giving information about our patients to anyone without their permission. (Who knew how handy this would turn out to be?)"

Posted by Elizabeth Cooney at 04:32 PM

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Wednesday, July 18, 2007

Legislators may tinker with health insurance law

By Alice Dembner, Globe Staff

The state Legislature will probably make a round of changes in the one-year-old law mandating near universal health insurance, but not before late fall, according to Senator Richard T. Moore, co-chairman of the Joint Committee on Health Care Financing.

The committee heard testimony today from about two dozen advocates, medical providers, patients, and self-employed individuals pressing for changes in controversial aspects of the law, such as how much employers should contribute to health insurance and the most individuals should have to pay for coverage.

More than 75 senators and representatives have signed on as sponsors of a bill to modify the law, called S661 and H1166.

During testimony, Moore said he endorsed a proposal to require that businesses pay at least 50 percent of the premiums for employees’ health insurance if they want to avoid a penalty of up to $295 per employee. Currently, the requirement is 33 percent, set by the administration of former Governor Mitt Romney. Two weeks ago, Moore asked the administration of Governor Deval Patrick to make the change.

If they don’t, he said, “it’s my intention that would be put into the statute.” But he said there was no rush to do that. His co-chair, Representative Patricia Walrath, was mum for now on the issue, although she has previously said she wanted a tougher business requirement.

Other changes proposed at the hearing included setting the maximum that anyone would have to pay for insurance – including premiums, copayments and deductibles – at 10 percent of income. The Commonwealth Health Insurance Connector, the state agency implementing the law, has set limits based only on premiums, and costs for many individuals and families are certain to top 10 percent.

After the hearing, Moore said he wanted to wait for financial analysis on the cost of some proposed changes, as well as a report from the state’s Inspector General on the law’s implementation, before deciding what changes to push forward.

“A couple more months will give us a better handle” on what’s needed, he said.

Posted by Karen Weintraub at 06:26 PM

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Thursday, July 12, 2007

Prescription drug requirement to get more review

By Alice Dembner, Globe Staff

State officials today voiced support for a plan that could cut the cost of monthly health insurance premiums for basic coverage that includes prescription drugs.

Staff members of the Commonwealth Health Insurance Connector, with the help of pharmacy consultants, proposed a plan that would add only $20 a month to premiums, far less than the typical $50 to $55.

The plan mandates use of generic drugs whenever possible and would cover all generics for a small copayment. However, it would require a deductible of $500 or more for most brand name drugs, in addition to sizeable copayments. Brand name drugs account for the bulk of the cost.

Members of the connector board generally endorsed the proposal, although they postponed a vote until they see how insurers would apply it in real life.

“I like the idea, but I’d rather see lower deductibles and higher copays on brands,” said Celia Wcislo, a board member and assistant division director of labor union 1199 SEIU.

Louis Malzone, executive director of the Massachusetts Coalition of Taft-Hartley Funds, a group of private health plans jointly managed by unions and management, was concerned about how the proposal would play out for older insurees, who face higher premium prices.

As the next step, staff members will get actual premium prices and a proposed schedule of copayments and deductibles from the six insurers who are offering unsubsidized health coverage through the connector.

The board would then evaluate the proposal as an alternative to rules that require all residents to have health insurance that includes drug coverage with no more than a $250 deductible.

Posted by Karen Weintraub at 02:51 PM

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Financial problem averted for health insurance plan

By Alice Dembner, Globe Staff

All four of the companies running new subsidized health insurance plans have agreed to a contract extension that will pay them 4 percent more per enrollee, state officials announced today.

The agreement, which will cost the state about $16 million more, averts a potential budget crunch that had state officials worried. Some of the companies had been asking for significantly more money.

The companies currently serve about 92,000 low-income residents in the Commonwealth Care program and are working to enroll thousands more. The contracts now run through the end of fiscal 2008.

The two companies that have enrolled the lion’s share of new insurees – Boston Medical Center HealthNet Plan and Network Health – also have yet to secure licenses from the state Division of Insurance, which are required by the federal government.

Patrick Holland, chief financial officer for the Commonwealth Health Insurance Connector Authority, said he was confident that they would be licensed by the end of 2007, about six months after the federal deadline.

The other two plans, Neighborhood Health Plan and Fallon Community Health Plan, are already licensed.

Posted by Karen Weintraub at 02:02 PM

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Connector counts 27,000 newly insured people

The number of newly insured Massachusetts residents rose by about 27,000 people before the July 1 deadline to obtain coverage, the state agency implementing the healthcare law said today.

That brings the total number of newly insured people to more than 155,000, according to a Commonwealth Health Insurance Connector statement. Among them are 15,000 members who enrolled in unsubsidized insurance plans in May and June through the Connector, their employers or directly with insurers.

About 2,500 people bought private insurance through the Connector's Commonwealth Choice program since it went on sale in May, a figure that is 50 percent higher than anticipated, according to the Connector. The others purchased plans through work or from insurance companies. Another 200,000 to 270,000 uninsured people still face the requirement to buy private insurance.

Last month 12,000 people signed up for subsidized coverage through the Commonwealth Care program, bringing the total to 92,000, about 20,000 more than projected by this time.

An estimated 44,000 to 68,000 eligible for the program have yet to sign up. Of those who have enrolled, about 83 percent are getting a full subsidy.

The Connector also said that 1,100 businesses have agreed to allow part-time and contract workers to buy health insurance through pre-tax payroll deduction plans. Some of the employers adopting the plans through the Connector are Boston College, Boston Red Sox, DeMoulas Market Basket, Dunkin Donuts, Gap, Partners HealthCare and TJX.

Adults uninsured by the end of the year, and who do not qualify for an exemption, will lose their state personal income tax exemption, a penalty that will rise in subsequent years.

Posted by Elizabeth Cooney at 12:09 PM

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Wednesday, July 11, 2007

New prescription drug requirement proposed

By Alice Dembner, Globe Staff

Since state officials approved a plan in March to require all Massachusetts residents to have prescription drug coverage, those officials have been searching for ways to keep drug coverage from driving up monthly health insurance premiums.

Today, staff members of the agency overseeing the new health insurance requirement proposed a plan that would add about $20 a month to premiums - far less than the typical $50 to $55. It would cover generic drugs for a small copayment, but would impose a $1,000 deductible on most other medicines.

The proposal will go before the Commonwealth Health Insurance Connector board tomorrow morning as a possible alternative to existing rules, which require drug coverage with no more than a $250 deductible. If approved, the proposal would set the minimum drug coverage that would meet state requirements that all adults have insurance. The rules apply to private insurance plans.

While all adults must obtain insurance this year - if it is affordable - their insurance doesn't have to cover drugs until Jan. 1, 2009.

Posted by Karen Weintraub at 02:30 PM

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Monday, July 2, 2007

Hungry for information

By Alice Dembner, Globe Staff

The state has been flooded with inquiries about the requirement that every adult obtain health insurance this year if it is affordable.

Calls, e-mails and visits to the Commonwealth Health Insurance Connector soared over the last month, reaching 70,000 last week, according to a connector spokesman. That's up from 25,000 inquiries in mid-May, before advertising campaigns began.

The official deadline for getting coverage was yesterday, but there is a grace period until just before the end of the year.

The connector, the new state agency overseeing implementation of the requirement, doesn't yet have an updated tally on how many are newly buying insurance. As of last month, about 135,000 of the approximately 400,000 to 500,000 uninsured had obtained coverage, either through new subsidized state plans or through Medicaid.

Other people are buying unsubsidized coverage through the connector or from insurers, and still others are newly insured through work-based plans.

Information on the law and new coverage options is available via the connector and

Posted by Karen Weintraub at 03:04 PM

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Tuesday, June 26, 2007

Insurance initiative could face budget crunch

By Alice Dembner, Globe Staff

Some of the companies running new subsidized health insurance plans are asking for more money than the state is willing to pay, a Massachusetts official said today, and could precipitate a budget crunch for the state's health insurance initiative.

Under state contracts, four companies now serve about 80,000 low-income residents in the Commonwealth Care program and are working to enroll at least 60,000 more. The state wants to extend their contracts by six months, until June 30, 2008, but the companies are bargaining for a larger fee, according to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector, which oversees the program.

State negotiators have offered a 4 percent increase, and agreed to pick up more of the cost if expenses rise significantly, Kingsdale told members of the connector board. That would add about $16 million to the state's cost, money that is already built into the fiscal 2008 budget now being finalized by the Legislature. However, that could leave little room for other possible increases in expenses, if enrollment is higher than expected, for example.

From the companies' point of view, "it’s not enough,” Kingsdale said, “and from a budgeting perspective, it’s probably too much.”

The companies are used to working in a climate where doctors and hospitals demand increases of 5 to 10 percent every year, Kingsdale said. But the state needs to keep cost increases to single digits, he said.

"The sustainability of health reform hangs on that," he told the board at a morning meeting.

Kingsdale said he thinks one or two of the companies would agree to the 4 percent increase. If the others don't, the connector would seek new bids from the companies. In that case, enrollment could be suspended until a new contract is signed, Kingsdale said.

Board members suggested that Kingsdale hold the line in negotiations. "Otherwise you’re trapped in a spiral upwards," said Dolores Mitchell, a board member and executive director of the Group Insurance Commission, which manages state employees' coverage.

Officials for the four companies -- Network Health, Boston Medical Center HealthNet Plan, Fallon Community Health Plan and Neighborhood Health Plan -- either declined comment or did not respond to a request for comment.

Posted by Karen Weintraub at 06:15 PM

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Monday, June 25, 2007

Getting medical devices to talk to each other

By Elizabeth Cooney, Globe Correspondent

There is no shortage of examples to illustrate the frustrating technological gaps that can put patients’ lives at risk, Dr. Julian M. Goldman told a conference on health care technology and safety yesterday.

Take the ventilator used during heart surgery, for instance, the Massachusetts General Hospital anesthesiologist and biomedical engineer said. The patient needs the ventilator both before and after using the heart/lung machine that pumps blood during heart surgery. But doctors can forget to turn the turn the ventilator back on – and the alarm that signals when the machine isn’t working is often silenced because it tends to go off unnecessarily. It would make sense if there were an alarm that sounded only when both machines were off, but that's not possible, Goldman said, because the two machines, made by different companies, can’t talk to each other.

"There's no shortage of clinical scenarios," Goldman, of Massachusetts General Hospital, said in an interview, after a morning filled with stories of fragmented health information. "The challenge is to turn war stories into actionable solutions."

Interoperability – the way for medical devices to work together – is the subject of the three-day conference that started in Cambridge today and is sponsored by the Center for Integration of Medicine and Innovative Technology among others. The conversation includes electronic health records in all settings and remote monitoring of health conditions.

Dr. Robert M. Kolodner, National Coordinator for Health Information Technology, challenged audience members from health care, business and government to forget their professional roles for a moment.

“Make it personal. Think about the quality and value of the health care services you and your family demand."

Posted by Elizabeth Cooney at 03:08 PM

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Friday, June 22, 2007

Soaring costs threaten universal coverage in Switzerland

By Alice Dembner, Globe Staff

While Massachusetts is the first state to require every adult to have health insurance, Switzerland led the way internationally, imposing a similar mandate on its 7.4 million residents in 1996.

Like the Massachusetts law, the Swiss initiative did not include any significant cost containment measures and that is one of Switzerland’s biggest mistakes, according to Ruth Dreifuss, who was a top official in the Swiss government.

Speaking today at a forum about the Swiss plan and its lessons for Massachusetts, Dreifuss said the cost of healthcare has soared, and with it, the price of premiums and the cost to taxpayers of insurance subsidies for low-income people.

About one-third of the Swiss people get subsidies. And some of those who don’t are paying as much as 16 percent of their income for healthcare, according to Beatrice Schaad Nobel, a Swiss journalist who also spoke and who just completed a report on the Swiss program for the Massachusetts Health Policy Forum, a nonprofit group that aims to improve healthcare here. The Forum and Health Care for All sponsored the talk.

The Swiss initiative has brought universal coverage and continues to have broad support, Dreifuss said. But "a system with no cost containment is not a sustainable one," she added. "I am worried about the future."

What can be done? The Swiss are still trying to figure that out. But Dreifuss said more managed care is one possibility, as well as setting up a government system to pay for the largest healthcare costs. The latter suggestion, called reinsurance, has also been floated here, but rejected so far on both sides of the ocean.

Nobel also suggests that unfettered competition among insurers might help, as well as larger copayments for patients who opt out of managed care programs that control access to specialists and hospitals.

In Massachusetts, the issue of cost control has been left to a newly appointed Quality and Cost Council, which has just set goals for this year that include finding ways to prevent unnecessary hospital stays and providing consumers with comparative cost data on hospitals.

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Tuesday, June 19, 2007

Most want free care pool to remain unchanged

By Alice Dembner, Globe Staff

The more things change…

As part of the state's health insurance initiative, the "free care pool," which pays for treatment for the uninsured, is supposed to be revamped.

But at a session this afternoon to gather suggestions about changes to the pool, speaker after speaker told state officials that the pool needs to remain pretty much unchanged.

For low- and moderate-income people who remain uninsured, the pool should continue to cover all medically necessary services, including preventive care, substance abuse treatment, prescription drugs and hospital treatment, speakers from various hospital organizations, community health centers and advocacy groups said.

And it should help those with low incomes whose insurance has gaps, and cover bills that hospitals can’t collect from low-income patients, the speakers said.

"It’s functioned well," said Pat Edraos, policy director for the Massachusetts League of Community Health Centers. "Don’t make it any worse until the glitches are worked out" of the health insurance initiative.

The lone dissenter was the Massachusetts Association of Health Plans, which suggested limiting the coverage to a smaller group: those people not eligible for Medicaid or subsidized insurance; those who get waivers from the state’s new insurance requirement; and those with medical hardships.

The state Division of Health Care Finance and Policy is working on new regulations –- expected in mid-July -- to define who will be eligible and what services will be covered under the pool’s successor, to be called the Health Safety Net Trust Fund.

The assumption is that the fund won’t be needed as much, since more people will be insured. And the state is counting on using a big chunk of the $600 million that now goes to the pool to pay for insurance subsidies for low-income patients.

As of March, according to the Massachusetts Hospital Association, pool costs are down about 11 percent, compared with last year. The state’s own accounting is expected next month.

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Friday, June 15, 2007

Program aims to cultivate universal insurance in other states

By Alice Dembner, Globe Staff

In many states, Massachusetts is serving as a model for efforts to expand health insurance.

Now, with the help of a Massachusetts organization, the grass-roots work that helped propel reform here will be cultivated in other states.

Today, the Robert Wood Johnson Foundation is announcing a $12 million program, called Consumer Voices for Coverage, that will be based in Boston at the offices of Community Catalyst, a 10-year-old non-profit group that works to expand consumer action to improve the healthcare system.

The program will provide $750,000 grants to community groups in each of 10 states -- yet to be selected -- to help foster universal health insurance. The goal is to create a broad healthcare advocacy network in each state pressing for change.

"At the end of three years, hopefully we'll have 10 states with significant reform," said Robert Restuccia, executive director of Community Catalyst.

The initiative grows, in part, from a report released last fall by Community Catalyst called "Consumer Health Advocacy: A View from 16 States."

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Wednesday, June 13, 2007

On the blogs: wait 'til next year

On A Healthy Blog, John McDonough of Health Care For All comments on the Commonwealth Fund report that ranks Massachusetts eighth in the nation on measures of health care access, quality and cost.

As noted by Alice Dembner here this morning, the state's performance was uneven.

McDonough thinks the picture is brighter today.

"Room for satisfaction and pride. Room for improvement. Worth remembering — data is from 2003-2005. If it were data from today, we would 100% surely be #1 on access, and probably better on quality," he writes. "Got to focus on costs, got to focus on healthy lives and public health."

Posted by Elizabeth Cooney at 01:33 PM

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Monday, June 11, 2007

The cost of health

People do put a price tag on their existence, a story in a special section on the business of health says in today's New York Times.

Studies of real-world situations produce relatively consistent results, suggesting that average Americans value a year of life at $100,000 to $300,000, Peter J. Neumann, director of a program at Tufts-New England Medical Center that measures the cost-effectiveness of new treatments, told the Times.

The story also quotes David Cutler, a professor of economics at Harvard and author of "Your Money or Your Life: Strong Medicine for America’s Health-Care System." He says such estimates have value, at least as guides to the diseases and conditions that people will spend the most to avoid.

kingsdale150.bmpAlso in the Times section, Jon Kingsdale (left) of the Commonwealth Health Care Connector and John McDonough of Health Care For All describe the challenges of implementing Massachusetts' new healthcare law.

"We’ll try to be the test laboratory for the rest of the country," Kingsdale said.

Posted by Elizabeth Cooney at 08:25 AM

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Monday, June 4, 2007

More signing up for subsidized insurance

By Alice Dembner, Globe Staff

Another 10,000 people enrolled in state-subsidized health insurance plans last month, the state announced yesterday, bringing the total to more than 79,000.

The plans, called Commonwealth Care, are open to adults without access to insurance at work who make up to $30,630 a year as individuals or $61,950 for a family of four.

Between 50,000 and 80,000 eligible individuals have yet to sign up, depending on who's counting.

For information on the plans, call 877-623-6765 or go to

Posted by Karen Weintraub at 04:39 PM

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Wednesday, May 30, 2007

Promoting insurance through My Space

By Alice Dembner, Globe Staff

Reaching out to the young crowd, an health insurance advocacy group in North Adams has set up a MySpace page to encourage enrollment in the state’s new health plans.

In the first 12 days, Ecu-Health Care’s page received 642 views and has signed up 140 "friends," who are contacting others about the requirement that every adult in the state have insurance by July 1.

"It's a great way to network," Charles Joffe-Halpern, executive director of Edu-Health Care said in an e-mail. "One ‘new friend’, a local pizza restaurant, agreed to send notices about health care opportunities to their 1,000 friends. Health care outreach in the 21st century."

How well this translates into insurance sign-ups is yet to be seen, he said.

"It’s just one part of the strategy," said Joffe-Halpern, who also sits on the board of the Commonwealth Health Insurance Connector, which is overseeing implementation of the health insurance law. "We have to go where kids live."

Check it out at

Posted by Karen Weintraub at 03:41 PM

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Wednesday, May 23, 2007

First residents sign up for new state health insurance coverage

By Alice Dembner, Globe Staff

A 63-year-old Bedford couple are the first purchasers of the new non-subsidized insurance plans offered through the Commonwealth Health Insurance Connector.

Parimal Patel drove all the way to the processing center in Worcester a few weeks ago to present his check for the first month's premium, even though the insurance doesn't kick in until July 1.

In his first interview with the media, he said today that he wanted to be sure the check didn't get lost in the mail or in a crush of other people applying for coverage.

He is paying $1,350 a month total for himself and his wife, Ruth, both of whom have diabetes. He purchased a comprehensive, but not top-of-the-line plan offered by Blue Cross Blue Shield as part of the Commonwealth Choice products.

"It's not exactly cheap, but it's about 30 percent cheaper than the market rate," said Patel, who retired early from management at Thermo Electron Corp. in Waltham and whose work-based insurance will end June 30.

The new insurance, he said, will tide the couple over until they qualify for Medicare in a few years.

Posted by Karen Weintraub at 04:33 PM

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Monday, May 21, 2007

On the blogs: Swiss healthcare parallels, latest hospital infection rates

On WBUR's CommonHealth, Béatrice Schaad Noble, a Swiss journalist who is getting her master’s in public health at the Harvard School of Public Health, explains how Switzerland approached universal health insurance coverage.

"Switzerland has gone through the same problems Massachusetts is facing now. Eleven years ago, pockets of resistance were strong. Some people deeply disliked being forced to buy coverage," she writes. "Today resistance has completely disappeared. Last March Swiss have even refused in a vote to shift to a single payer system."

On Running a Hospital, Beth Israel Deaconess CEO Paul Levy posts the latest report on central line infection rates. In the past he has challenged other hospitals to do the same.

"The overall quarterly trend is in the right direction, but as you can see ..., there is troublesome variation from time to time," he writes. "The up's and down's, I guess, are normal, but we all wish they stay down."

Posted by Elizabeth Cooney at 11:22 AM

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Wednesday, May 16, 2007

Health insurance law under discussion

By Alice Dembner, Globe Staff

For an interesting overview of Massachusetts' efforts to get nearly everyone in the state health insurance, check out the conversation with Jon Kingsdale on The Health Care Blog, a national blog run by a healthcare consultant.

Kingsdale, executive director of the Commonwealth Health Insurance Connector, focuses on some of the misconceptions about the initiative, as well as some of his hopes for the future of the effort. The connector is the quasi-public agency overseeing implementation of the healthcare law.

Posted by Karen Weintraub at 11:50 AM

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Thursday, May 10, 2007

Roadblock looms for subsidized insurance plan

By Alice Dembner, Globe staff

The chief financial officer for the Commonwealth Health Insurance Connector today said he was "a little concerned" that HealthNet, run by Boston Medical Center, would not meet a federal deadline to secure an insurance license by the end of June.

Patrick Holland today told members of the connector board that BMC hadn't provided the connector with information on its progress toward getting a license from the state Division of Insurance. That license requires proof of financial reserves, among other measures.

If HealthNet doesn't get the license, it could no longer provide coverage under the state-subsidized health insurance program. So far, HealthNet has enrolled about 40 percent of the nearly 70,000 people in the program. Three other plans enroll the remainder.

In a statement after the meeting, HealthNet executive director Jean Haynes, said the "BMC HealthNet Plan meets all applicable commercial HMO and National Association of Insurance Commissioners solvency requirements." She did not address whether the plan would meet the licensing deadline.

Later in the day, the plan released another statement: "BMCHP has always and will continue to meet all of the requirements of the Connector."

Posted by Karen Weintraub at 05:26 PM

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Connector board member resigns

By Alice Dembner, Globe staff

Bruce Butler has resigned from the Commonwealth Health Insurance Connector board.

Governor Deval Patrick will appoint a replacement to the board that is overseeing implementation of the new mandatory health insurance law.

Butler, a former chief actuary for Blue Cross Blue Shield, filled the board seat designated for an actuary. He resigned effective last week, board chairwoman Leslie Kirwan announced today at the monthly board meeting, because the "duties of the board were conflicting with his professional life."

Earlier this year, Butler curtailed some consulting work to avoid a conflict of the interest with the connector. In his resignation letter, he wrote, "I am not able to pursue my independent consulting business adequately while serving on the board."

Posted by Karen Weintraub at 04:15 PM

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Friday, May 4, 2007

New site for health insurance information

By Alice Dembner, Globe Staff

Looking for information on the new health insurance plans offered by the state?

There's a new website to guide people through the complex maze of choices -

The site is the work of the Commonwealth Health Insurance Connector, the state agency overseeing implementation of the new health insurance law that requires all adults to have coverage by July 1.

The site focuses on the plans without state subsidies. It also includes information on how businesses can sign up to offer their employees these new plans.

Posted by Karen Weintraub at 05:56 PM

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Tuesday, May 1, 2007

State health insurance plans hit the market today

By Alice Dembner, Globe Staff

A state agency today began selling new unsubsidized health insurance policies, some with premiums significantly lower than market prices.

The policies are aimed at about 200,000 people who don't have insurance, who don't qualify for state subsidies, and who are required by state law to buy coverage this year.

Coverage ranges from basic to comprehensive in the four tiers of policies offered. The basic policies have lower premiums but require higher out-of-pocket payments for care. The more comprehensive policies have higher premiums that cover most health costs without additional fees.

Special stripped-down policies are available for young adults, ages 19 to 26.

The coverage, called Commonwealth Choice, is provided by Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan and Tufts Health Plan.

For information, contact the Commonwealth Health Insurance Connector or telephone the call center between 8 a.m. and 6 p.m. Monday through Friday at 1-877-623-6765.

Posted by Karen Weintraub at 01:05 PM

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Thursday, April 12, 2007

Board approves exemptions to health insurance law

By Alice Dembner, Globe Staff

A state board voted unanimously this morning to allow about 20 percent of the state’s uninsured adults to avoid buying insurance. A law requiring coverage for everyone who is not specifically exempted takes effect July 1.

The Commonwealth Health Insurance Connector board decided that even the lowest-cost insurance would not be affordable for about 68,000 individuals with low and moderate incomes.

The board also extended free coverage to individuals earning up to about $15,000 a year and families of 4 earning up to $31,000, and reduced the cost of insurance by $5 a month for those earning between $15,000 and $20,000 who are eligible for Commonwealth Care.

Board members yesterday said the moves were a compromise, designed to provide affordable coverage for 99 percent of the state’s population, but also provide an exception for those who would be truly burdened by the monthly premiums. People who are exempt will continue to be able to get emergency care through the state’s free care pool.

A person would be automatically exempted for example, if he or she earned about $33,000 and can’t find coverage for less than $150 a month. A family earning would be exempt, for example, if it earned up to $70,000 and could not find insurance premiums for $320 or less.

Posted by Karen Weintraub at 10:23 AM

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Wednesday, April 11, 2007

About 20 percent of uninsured would be exempted from state law

By Alice Dembner, Globe Staff

About 20 percent of uninsured adults would be exempted from meeting the state's new requirement that everyone have health insurance, under a proposal that will be voted on tomorrow by a state board.

The proposal, from the staff of the board overseeing implementation of the new universal health insurance law, estimates that even the lowest-cost insurance would not be affordable for about 68,000 individuals with low and moderate incomes.

In addition, the staff proposal would expand subsidies for the lowest-income families who qualify for a state-sponsored insurance program called Commonwealth Care.

This would extend free coverage to individuals earning up to about $15,000 a year and families of 4 earning up to $31,000. It would also reduce the cost of insurance by $5 a month for those earning between $15,000 and $20,000 who are eligible for Commonwealth Care.

The increased subsidies would cost the state about $13 million more than the $470 million estimated for the fiscal year that starts July 1.

"The proposal represents a reasonable way to determine generally whether insurance is affordable for most people," wrote Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector in a memo outlining the proposal to board members.

"If we do not find a way to oblige most individuals to participate, healthcare reform will fail to achieve its promise," he wrote. "However, we are walking a tightrope."

The proposal adopts some of the recommendations of a coalition of advocacy, labor and medical groups that had argued that applying the insurance mandate to people who couldn't afford it would undermine public support for the initiative.

But the statff proposal requires Massachusetts residents to pay a higher percentage of their income toward health insurance than that coalition suggested was affordable.

Under the law, all adults must have insurance by July 1 or pay a penalty. The penalty, initially about $200, will be imposed on those who do not have insurance by Dec. 31.

Individuals making about $33,000 a year would be required to comply with the law if they can find an insurance policy that meets state standards and that costs $150 a month or less, about 5.5 percent of their income, according to the staff proposal. The coalition had proposed that the limit be set a 4.5 percent of income and include not only premiums, but some out of pocket expenses.

The proposal also allows individuals to apply for hardship waivers of the law.

Posted by Karen Weintraub at 09:08 AM

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Monday, April 9, 2007

Coalition calls on state to make health insurance more affordable

By Alice Dembner, Globe Staff

The state isn't yet doing enough to help people of low- and moderate incomes afford health insurance, a coalition of advocacy and medical groups told Governor Deval Patrick today.

The Affordable Care Today coalition, which helped secure passage of the state's health insurance law, called for the state to increase subsidies for those with the lowest incomes and to allow people with moderate incomes to opt out of the health insurance requirement if they would have to spend more than 4 to 8 percent of their income paying for it. Download file

The governor’s spokesman Kyle Sullivan, said that Patrick would review the proposal, along with others, as he seeks to strike a "delicate balance."

"He believes we must be ambitious in expanding coverage without imposing financial hardship on those who truly cannot afford health insurance," Sullivan said.

The board that is charged with implementing the law, the Commonwealth Health Insurance Connector, is due to set preliminary rules Thursday on who should be exempted from the law because health insurance would be unaffordable for them.

Rev. Hurmon Hamilton, pastor of Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, said the coalition's proposal would protect the most financially vulnerable while ensuring that about 75 percent of those without insurance would be covered.
"We want to bring people as much healthcare as possible, not squeeze folks as much as possible," Rev. Hamilton said.

A proposal from another advocacy group, Community Catalyst, released last week, suggested that individuals earning less than $30,000 a year be exempted from any penalty if they don't get insurance. That group also suggested that people earning between $30,000 and $60,000 be exempted if they had to spend more than 4 to 8.5 percent of their income on health insurance.

However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology and a member of the Connector board, presented a report last week that suggested nearly everyone could afford insurance and no broad waivers were needed.

Many observers suggest that finding a workable compromise on this question will make or break public acceptance of the new law.

The coalition proposal suggests that the state provide fully subsidized insurance to people earning up to $15,000 a year, an increase from the current $10,000. In addition, it suggests lowering premiums for those earning $15,000 to $30,000 to 1 to 3 percent of income. Individuals earning between $30,000 and $60,000 would be exempted from buying insurance at market prices only if the premium and deductible cost more than 4 to 8 percent of their income based on a sliding scale, the proposal suggests.

The proposal would add $12 million to $16 million to the cost of state-funded premiums, according to the coalition. It would also likely exempt more people than some policy-makers consider feasible to make the law work.

Posted by Karen Weintraub at 06:05 PM
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