Massachusetts Health Insurance Law Truth - Truth vs. Spin

SPIN: "Everyone who can’t afford insurance is eligible for help paying for it."

TRUTH: Payment help ("subsidy") for health insurance is limited limited to those whose gross income is 300% FPL and below. Living costs are very high in Massachusetts. According to the Kaiser Family Foundation, a family of four would need to earn $63,000 a year to equal the purchasing power of 300% of the U.S. Federal Poverty Level in 2008. Massachusetts's cost of living is 22.18% higher than the U.S. average. See FPL income rates here.

Anyone making more than 300% FPL gets no help. Period. Not even those who are eligible for the Connector’s special plans (Commonwealth Choice). In effect, the less you make, the better off you are in terms of getting help. If you make even a penny over the limit, it will cost you additional hundreds, and in some cases, thousands, in order to comply with the mandate. This is a regressive system that discourages getting ahead. Many taxpayers are declining extra work, overtime, bonuses and raises so they won’t wind up worse off for having made the extra money.

Middle-class taxpayers not eligible for the Connector’s Commonwealth Choice plans are forced to purchase insurance on the open market. This can cost up to and over 20% of an individual's or a family's income and is guaranteed to

increase yearly.

There is also no help for those for whom employer-based insurance doesn’t fit into the household budget. See Crowd-out protections. This is a painful "between-a-rock-and-a-hard-place" problem and forces many to accept being a criminal and pay the tax penalties that may also be unaffordable.

SPIN: "Low-cost plans are available for ages 19-26 (Called "Young Adult Plans")

TRUTH: The cost of the Young Adult Plans are lower than those mandated for older individuals, but they don't provide much in the way of coverage and still feature high deductibles and co-pays along with yearly or lifetime limits.

Young Adult plans provided through Commonwealth Choice are exempt from the "minimum creditable coverage" rules and, thus, expose this group to untold health and financial risks. In essence the young are forced to pay relatively high premiums for the privilege of propping up the system while remaining legally UNDER-INSURED.

SPIN: "Connector programs lead to accessible, quality coverage"

TRUTH: Connector-sponsored health insurance plans as well as the state-subsidized Commonwealth Care plans are all based on the commercial Managed Care Organization (MCO) model of insurance. The purpose of this model is just what it says, to manage your health care. This is not your doctor, but an administrator in some far flung office. The purpose of the MCO is to limit coverage whenever possible, so as to minimize expenses and maximize profits for it's company and stockholders. Doctor visits, medications, surgeries and hospital stays among other medical care needs are strictly controlled. Patient preference and convenience is easily disregarded in favor of the plan's regulations and limits.

On top of that, in many areas of Massachusetts it is very difficult to find a doctor who will accept Commonwealth Care MCO members. The reason for this is that law has greatly reduced provider payments while placing a large and growing administrative burden on them. See Boston Globe article for an excellent details here.

The law has devised a large, costly system of monitoring "quality".
This is known as the Health Care Quality and Cost Council whose job it is to establish health care quality improvement and cost containment goals. Please take note of the last part of their mission: "cost containment.” So far, not good. We can’t speak to quality, but it stands to reason that if low-income and others can’t find doctors who will see them, quality is a moot point. In fact, this defeats the stated goal of preventative care and early intervention.

Capitation and doctor-hospital tiering are currently being implemented across the state. Touted as “health care cost reform,” this has very little to do with cutting your costs and ties the hands of the doctors who want to do their jobs which also affects you. Health care cost containment of this nature unequivocally puts the insurers in the driver’s seat, and, we already know what their goal is. We will bring you more on this soon.

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Truth vs. Spin: The Massachusetts Health Insurance Mandate Page 4
	See the TRUTH INDEX