In the press, the statute has been touted as providing “universal care,” but critics doubt that the coverage will be truly universal. For instance, they claim, based on U.S. Census data, that the number of uninsured in Massachusetts is closer to 714,000—not the 500,000 that resulted from bilingual telephone surveys used by those who drafted the bill. Those who espouse a single-payer solution to the insurance crisis, such as Physicians for a National Health Policy and Mass-Care (the statewide coalition of organizations that back single-payer healthcare), argue that mandating purchase of individual plans will shut many working families out of the market. Even administrators and physicians interviewed for this article admit that to generate affordable policies, insurers may have to limit networks and benefits. And increasing the number of insured citizens may have no effect on the rising tide of healthcare delivery costs. With so many unknowns, and a complicated administrative system to initiate, the task of fulfilling the statute’s mandate is daunting.
Where It Is Now
Reached in mid-July between meetings, Jon M. Kingsdale, PhD, newly appointed executive director of the Commonwealth Health Insurance Connector Authority, reported that his board had met five times since June 7. Included in its busy schedule: generating a plan of operations and a budget and hiring staff. The Connector also met its first legislative deadline, which was to develop and issue regulations and criteria by July 1, 2006, for contracting with health plans for the Commonwealth Care Health Insurance Program, or C-CHIP. This is the state-subsidized health plan for people earning up to 300% of the federal poverty line that will begin on October 1, 2006. Key features of C-CHIP and other components of the Massachusetts health reform include no premiums for those who earn less than 100% of the federal poverty line, increased coverage for children, and increased Medicaid reimbursement rates for providers (a good thing for hospitals). Premiums for those earning 100%-300% of the federal poverty line will be set according to a sliding scale, but none of the C-CHIP plans include deductibles. Funding for this plan will come from federal and state matching Medicaid funds made possible by a waiver currently being negotiated between Massachusetts and CMS. (Formal approval had not yet been granted by CMS as of July 21.)
As to the insurance products for those earning above 300% of the federal poverty level, Dr. Kingsdale says The Connector board will address affordability criteria once C-CHIP deadlines have been met. The legislation calls for The Connector to provide its seal of approval for plans that are offered and make determinations about continuing or withdrawing approval. After two years, the agency will formally evaluate the program and make recommendations for changes.
Reactions to the Plan
Joseph Li, MD, assistant professor of medicine at Harvard Medical School and director of the Hospital Medicine Program at Beth Israel Deaconess Medical Center in Boston, admits that his excitement about the insurance statute is somewhat tempered. His personal opinion, which does not reflect his group’s or hospital’s opinion—is that he will “believe it when it’s truly enacted.”
Massachusetts has passed healthcare care reform bills in the past: Witness the 1988 legislation under Governor Michael Dukakis that was later repealed. Nevertheless, Dr. Li says, “I’m glad to see it happen. A lot of people have been wondering how we are going to address the issue of the 45 million uninsured in this country. This is one step toward that, but there are really a lot of ifs, ands, and buts on whether it will truly be pulled off in a year or two.”