Will the plan work? There are at least as many skeptics as there are believers, and the question may be answered in the coming year as the law becomes reality.
As of July 1, every resident in Massachusetts is required to have health insurance or face a financial penalty. The state has created lower-cost, subsidized plans for those making 300 percent or less of the federal poverty level. Those making more but not offered insurance through work can now buy private
The hope is to extend insurance coverage to nearly every state resident, which would mean getting 300,000 people off the rolls of the uninsured.
The bill was meant to strike a balance between state intervention, private responsibility and corporate sponsorship. The three-legged stool was meant to give the bill strength, proponents say, while detractors warn that if one of the legs breaks, the entire program will collapse.
Jon Kingsdale is executive director of the Commonwealth Health Insurance Connector. A Ph.D. in economic history from the University of Michigan, he has taught at the Harvard School of Public Health and has worked as a
Under his leadership, the Connector has unveiled the subsidized Commonwealth Care plans and has approved a range of health plans for the Commonwealth Choice program for those above 300 percent of poverty.
"I am very optimistic that it is going to work," he said. "We have already extended coverage to 120,000 individuals who have real needs and who were not insured. I hear tremendous support for the law. ... There is a lot of appreciation for what the law is trying to do."
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But it has drawn criticism, however, from those who support universal health care, in which the government becomes the single payer, cutting insurance companies out of the market.
Dr. Michael Kaplan, a Lee, Mass., physician and an advocate of universal health care, said anything short of universal health care will fail because it won't create a mechanism to control costs. And because the health plans are still expensive — costing anywhere from $180 a month for an individual to $750, depending on age and location — many will not participate.
"It won't cover everybody, and it never will," Kaplan said. "It leaves the private insurance companies in charge, and in fact gives them more business. So we will be paying high overhead for a lot of the people being added to the system."
Kaplan said he expects one of two outcomes: Many people will ignore the mandate because they can't afford insurance so the law will be repealed, or the costs will be too much for the state to bear and the program will collapse.
The Massachusetts Association of Health Plans — a trade group that represents the insurers — agrees that costs will be too high, but not because of administrative fees for insurance companies.
Instead, Dr. Marylou Buyse, the MAHP's president and CEO, said the law will be challenged by the rising cost of medical treatment, not administrative fees.
"We are very supportive of health care reform and we have great expectations that it will work. But whether it works or not depends on whether we can figure out how to keep health care affordable in the long run," Buyse said.
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| For more information about the Commonwealth health plans, visit www.mahealthconnector.org or call the Commonwealth Health Insurance Connector Authority at 877-MA-ENROL (623-6765).
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As most with insurance can attest, the costs have risen far faster than the rate of inflation in Massachusetts. Unless that changes, Buyse said, insurance "will become unaffordable itself, since health care is increasingly unaffordable."
Charles Joffe-Halpern, the executive director of Ecu-Health Care in North Adams, Mass., and a member of the board that is overseeing the Commonwealth Health Insurance Connector Authority, said there will be "pleasant surprises" as the law is rolled out, "and less-than-pleasant surprises."
Commonwealth Care, which covers those making 300 percent or less of the federal poverty level, "will work fine" and is "extremely progressive. As long as the state economy holds up and is able to support the generous subsidies that are in place, then we will have made very productive and creative use of funds that used to go to the free care pool."
And he expects the Commonwealth Choice plans — which are not subsidized by the state but are still cheaper than the private market — to work for people making 500 percent or more of the poverty level.
"It's the 300 to 500 percent crew where we have much to learn," Joffe-Halpern said. "We will learn. All of us on the Connector board understand that we will learn from experience. None of us is entering this with an attitude of pathological certainty. We are open minded."
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