Proof someone is exempt from mandate?

Ann,

I just duplicated that discrepancy you mentioned... $100/month less when you list the younger spouse first. I guess you're asking too much, if you want this fixed while it still matters!

Interestingly, it quotes the same premiums whether you're a coal miner, a nuke plant technician, or a Masshealth bureaucract!

(1) "Do you know of other blogs outside of Mass where this kind of information from frontline workers would be useful to share?

Sorry but no. Occasionally the group in California will comment very generally on the progress of the MA plan but it is all very non-specific and conceptual policy oriented.

My state is working on the uninsured problem now and has applied to Medicaid for a waiver. Problem is that in a way they are trying to reinvent the wheel - who are the uninsured, why are they uninsured, and other information that is already well-documented in studies. I'm a dyed-in-the-wool public policy wonk trained in public administration and micro-economics as well as the JD. Being retired, I'm lending a hand as a freebie to them and the MA system details has become my bailiwick along with any new studies on affordability and the economic impacts of being uninsured and underinsured. The positive note is that with respect to my round-robin dissemination of information and analysis, the healthcare staffer for our senior US Senator has ask to be included. Any info back from you all would REALLY be appreciated. We are very very interested in the details of how this works on the front-lines. Should I just post my direct email?

(2) Health Care Responsibility Disclosure (HIRD) form to document when people decline employer sponsored coverage

Almost perfect! That is what I wanted to see in a letter from the employer. The only thing it seems to lack is the cost of the premiums so back to something on the employer's letterhead. That form plus a letter about premium costs and wage stubs/W-2 should be sufficent supporting documentation. Now the question is to what form does the documentation get attached to request the waiver.

What I see as a concern is that the Connector has set income affordability guidelines for those over 300% FPL which would automatically exempt them if the premiums are higher than stated in the schedule. Problem is that it sets up a catch-22. The regs say you must have a waiver to file with the tax returns. The only way to get a waiver is to go to the Connector and prove that based on their guidelines, you are exempt. Curious situation when the first bally-ho from Kingsdale and company was that it was an "automatic" exemption. The stuff in the news could be very misleading and people won't act - and come tax time, they will be frantic.

(3) Commonwealth Choice plans on the website

I have fooled around with the Commonwealth Connector website to help people select plans. http://www.mahealthconnector.org/portal/site/connector/

It has a problem. When I take 2 individuals as a couple and enter the younger one first, I get one price for premiums. When I put the older one first, I get a higher premium - as much as $93 more a month on the one test I ran. I emailed the Connector back in May when it first came on line and they said they were going to fix that but to rely upon the lower premium amount. First, they haven't fixed it as it was still doing it 2 days ago. Second, I have never encountered an insurer who didn't base the premium on the older person being first and not the younger.

I used zip codes for Salem and Plymouth, gave it the industry code of 0000, and ages of 52 and 59 in the test runs.

While the website says you can sign up there, I don't think the data on premium prices is to be trusted. Someone may want to check my test runs and see if they get the same problem and then nag the connector about this. May just be me but I find a annual premium difference of over $1100 pretty significant.

(4) Query - Do you know what is being done to inform the population about the income/premium rate affordability schedule? There is a lot of publicity about "you must get health insurance" but anything about the income/premium waivers or all the other grounds for waivers (and there are a LOT) are glossed over or ignored.

When I got quotes of $8004 (no prescriptions & younger first) to $10,368 (prescriptions & older first) for a couple in their early 50's, I was floored. Even at 584.5% FPL ($80,001), that would be nearly 13% of gross income not counting the $4000 deductible.

Without knowing about the income/premium affordability schedule because the website listed above simply ignores the issue, people are going to go to that website, be told they must buy insurance or be punished with tax penalties (and worse later) and, for those over 40 or with families, start getting these large quotes.

If my hypothetical couple in their 50s got those quotes and had an income of $50 -60K, but didn't know about the income/premium affordability schedule, you can be assured that they would start to panic. Talk about a way to create uncontrolled stress! Granted the average uninsured is 37 but that means that over 1/2 are older than 37 but younger than 65.

Many thanks to Lorianne Sainsbury-Wong from Health Law Advocates for supplying this answer:

Households between 0 to 150% of the federal poverty level (if you make up to $15,324 for a single person or $30,984 for a family of 4) with members who are not eligible for Commonwealth Care are the only 'guaranteed' exclusions from penalty. The Connector has not yet established this process, for example, whether a Commonwealth Care denial serves as sufficient evidence, etc.

Because Community Partners refers to $150.00, their client is 25 years old or less and at 300-350% FPL. The Connector will finalize its Premium Schedule to include age bands and geographic locations. These numbers are subject to change and will likely be finalized during next week's Connector Board meeting on Tuesday, June 26th.

There are two ways to avoid the tax penalty for not having insurance:
(1) Annual Certificates - the person must first have applied for a Connector product and they must apply for a Certificate in the current tax year.
(2) Appeal of Penalty - the person can file an appeal form with their tax return. If a penalty is assessed, the individual can appeal to the Connector.

Although nothing is guaranteed, the Connector affirms its commitment to a robust appeals process for 2007.

Ann

Thanks for jumping in on this. We in Mass. know that what is being done here is being tracked by other states. Its great that the details of implementation are being studied as well as the high-level policy since we know if it doesn't work on the ground, it won't work. Do you know of other blogs outside of Mass where this kind of information from frontline workers would be useful to share?

In terms of content, the Division of Health Care Finance and Policy is developing a Health Care Responsibility Disclosure (HIRD) form to document when people decline employer sponsored coverage. I would think that this might also serve as documentation based on what the Connector says will be included. Any thoughts you or others have after looking this over. Practical suggestions are welcome as July 1 approaches and questions increase.
http://www.mass.gov/Qhic/docs/HIRD_v19.pdf

I'm watching from the sidelines and tracking the MA program for the Governor's Committe on the uninsured for my state. Also I'm a reitred lawyer. Here is my lawyerly take on proof from a legal evidentiary angle and the process:
(1) They will need to have their paystubs - and W2s for the year in question.
(2) They will need to have a document from their employer showing that the employer offers health insurance - signed by a representative of the employer and not just a typed document which could easily be forged.
(a) It is best that it should be on the employer's letterhead with a real signature and the person's title.
(b) The letter should identify the carrier. It should identify the group policy number.
(c) It should state that the employee is eligible for the coverage.
(d) It should spell out exacly how much the premiums will cost the employee every month.
(3) Barring any contrary information from the Connector, I would have the client submit a formal request for a waiver through the Commonwealth Choice staff (if over 300% FPL as this person presumably is.) If the staff in that section is unsure about how to do it, send a copy by CERTIFIED mail of the hardship request and documents to that section and to the Board of the Connector. It is best to assume that agenices will bugger something up and that one needs written proof of the attempts to navigate the buearcracy - ergo the certified mail and keeping copies.
You may have to modify the hardship request form that has been issued and deal with the this type of request by a written explaination. It looks like that form was meant to go to the COmmonwealth Care section and not the Commonwealth Choice side.
http://www.compartners.org/pdf/news/6-14-07_premium_waiver.pdf
Tht may mean crosing out and changing the name on the form from Commonwealth Care to Commonwealth Choice. It may mean scanning it as a word doc and altering it.
This is going to be a HUGE issue for those over 40 (and especially those in their 50s) who are greater than 300% FPL - and it can, and will cause a lot of stress for the huge numbers of people above 300% FPL of whom over 1/2 are in their 40s or more where the premiums skyrocket beyond affordability at the income levels of 94% of the uninsured.