JOHN CARROLL

Massachusetts health officials say they've passed a key hurdle en route to near universal insurance coverage for state residents.

In February, Massachusetts Gov. Deval Patrick made an eleventh-hour appeal to a group of state insurance companies to come up with an affordable set of health plans for low-income working families. He was rewarded with a slate of new, high-deductible health plans that would cost between $175 and $288 a month for the average 37-year-old uninsured resident. Those costs rise with age.

Critics and supporters alike agreed the plan was likely to leave some of the state's uninsured – about one in 10 of the population – to conclude the cost of coverage was still too high. But in creating a state-mandated insurance plan, Massachusetts also is helping to create minimum standards for coverage in other states grappling with the same issue. And their approach, analysts say, is also likely to earn more than a few imitators around the country.

The biggest advantage that Massachusetts had in tackling the problem of the uninsured was its relatively low rate of people who lack coverage. But the region is far from the least expensive in terms of healthcare delivery.

"If we can do it in Massachusetts, they can do it in other states," said Dr. Marylou Buyse, CEO of Massachusetts Association of Health Plans. "A lot depends on the number of uninsured. Massachusetts has a high rate of insurance, and a well educated, affluent population. Our demographics are very different from many other states. The other thing that's different is that Massachusetts has always had guaranteed issue; anyone who wants insurance can obtain it."

But they couldn't always afford what was available.

Just last January, the state was startled by a first round of bids that offered coverage for an average of $380 a month – far higher than the $200 average that state officials had suggested was possible. Patrick said he personally called insurers to urge them to go back to the drawing board.

In this latest step, the state's Commonwealth Health Insurance Connector Authority – an agency created to implement the new insurance mandate – will be rolling out mandatory plans for people with incomes more than 300 percent of the federal poverty level. A set of subsidized health plans for people living with less than that is already available.

Under the state's health insurance law, all residents have to obtain some form of health coverage by July 1, with a minimum set of standards applying by January 1, 2009. Failure to comply would threaten residents with the loss of tax deductions. All plans are limited to a deductible of $2,000 with a maximum out-of-pocket expense of $5,000 for individuals when members stay inside their networks of providers. A drug plan with a $250 deductible is also required, which the state estimates will add another 5 percent to the monthly cost of the insurance.

Some of the plans have some stiff cost-sharing requirements. BlueCross and BlueShield of Massachusetts, for example, set up a $275-a-month plan that requires members to pick up 35 percent of hospital costs up to $5,000 for an individual and $10,000 for a family.

"It's not something that everybody without coverage will find affordable," said John McDonough, executive director of Health Care for All. But no matter what, he added, more people will be able to get insurance now than before.

"We vary from (former Massachusetts Gov.) Mitt Romney in that we have never called this universal healthcare," McDonough noted. "There will still be uninsured. I wish that final law would have had a genuine promise of covering everybody, but the benefit outstrips that disadvantage. After implementation, the mop-up work for residual uninsured will be far easier to handle."

The state also required insurers to make sure they were able to come up with plans that appealed to chronically ill residents who might be put off by the prospect of high deductibles.

"There are three levels of plans," McDonough pointed out. "A basic (or bronze) level, the value level, and the gold (premier) level. If you go above the basic level to middle or higher level, you will find plans with very limited cost sharing."

On the other hand, some who are already buying coverage say that the new plans offer a deep discount on what's been available up to now.

"I've already heard from folks," said McDonough. "There's one guy who's in his early 60s buying individual coverage. He told me he's going to save hundreds of dollars a month with these suckers."


May 2007