The dreaded Individual Mandate Call (IMC) usually begins, "I'm uninsured. I heard that a new law says that everyone in Massachusetts has to have health insurance by July 1st or they could get fined on their taxes." My fellow Helpline Counselors and I spend our days answering IMCs (over 800 last week between the four of us). Attempting to offer callers some sort of consolation when it appears that they may be penalized by the impending individual mandate has become a new challenge in recent weeks.
People are angry and, at times, very angry. Earlier today, a caller responded, "So you mean to tell me that I'm punished even though I only have $10 left each month for food after I pay my bills?" Then she violently hung up on me. This particular caller is single, works forty hours per week, and earns $11 per hour. Her employer offers her coverage, but it is too expensive for her. We hear this story often.
When fielding IMCs, we feel we have a responsibility to clear up the notion that everyone will be fined if they don't have health insurance. This is a huge misconception about the individual mandate that must be addressed. It is important to let people know about the affordability schedule, waiver possibilities, and any health insurance options for which they may be eligible, such as Commonwealth Care or Commonwealth Choice. This must be explained in terms that a person outside of the health policy world will understand. More importantly, it must be easy to comply with the mandate. Enrollment into a Commonwealth Care plan must become an easier process and waiver forms must be simple to find and complete.
Fielding IMC calls is not easy. Convincing someone, who is already struggling to get by financially, that they must make room in their budget for a health insurance premium, is difficult. But it must be done for health reform to be successful.
I absolutely agree with
I absolutely agree with Danna that the overall goal is being lost in the details. When one goes to other parts of the country, one realizes how "in awe" people are that the Commonwealth has accepted responsibility for making sure that as many people as possible have health insurance.
That having been said, I will reiterate two points that I continue to make. First, and only in passing, is that beneficiaries with Medicare have not been adequately informed that this does not apply to them. More important, the extant enrollment and outreach mechanisms which we have in place were designed to meet the needs of people under 300% FPL -- there really is no "network" of qualified counselors to give advice to those in the Commonwealth Choice program except for Paul who's peddling as fast as he can. IMHO, if we are going to REQUIRE citizens to have health care, we OWE IT TO THEM to provide personalized assistance -- although I have to say I'm amazed at the quality of the website and the acumen of the people at the other end of MA ENROLL. But some people need face to face -- especially small business.
Somehow people have not made the connection between mandatory insurance in other parts of their lives and this mandate. Because it's our own person, we think it belongs to us. And it does -- the Supreme Court says so. But we also live in a world where we expect our fellow citizens to step in and take responsibility for our healthcare if we can't. So we do have a responsibility to our fellow citizens to do what we can to relieve the moral and financial burden on them.
Tricky questions -- but worth educating people about!
I think the goal that every
I think the goal that every Massachusetts resident is to have health insurance is getting lost in all the "muddy details". The individual mandate should only be imposed when in fact there is affordable health insurance available for everyone. There are going to be so many people appling for waivers that it will be a huge mess! Adding to the already crammed job description of outreach workers.
And I agree that the employer mandate is so minimal that it only stirs up anger among the general public. I imagine that for most employers the amount of the penalty is a much smaller percentage of their profits than what the individual mandate requires of a persons income. Especially if you compare company profits to persons take home pay.
You're all so right! What
You're all so right! What this reminds me, once again, is what a crucial role outreach workers play in bridging the gaps between a giant bureaucratic program and each individual who needs it or will be affected by it. It's particularly important in a situation like this, where there's a lot of suspicion and misunderstanding, to have someone you trust close by to help you make sense of things. I hope the legislature will recognize this too and provide healthy support for outreach programs.
How incredibly tragic. It
How incredibly tragic.
It sounds as though practically all of you who posted comments here have drank the Blue Cross Blue Shield Insurance Industry "Roadmap to Coverage" Koolaid.
You are good people and I thought smart people. Then why oh why are you settling for this fake "reform" and the harm it is doing in our state and across the entire country?!!
Chapter 58 is a sham brought to us by the hc industry and the politicians they have bought and largely control.
Chapter 58 does practically nothing to improve the financing and delivery problems in our healhtcare system to use our healthcare resources more responsibly and effectively. People, please wake up to the reality here; it's our money that's being squandered in the current healthcare as commodity non-system!!!
Instead of making needed improvements, the law forces people into the private marketplace to purchase a shoddy insurance product sold to them at a profit.
Please wake up to these facts and join the growing movement for healthcare for all not private insurance for some and state permission to remain uninsured for the rest.
There is massive growing public opinion that is rejecting this harmful mandate law. People are beginning to insist that Chapter 58's insurance mandate be replaced with real reform that puts people and their healthcare needs before healthcare industry profits. See SiCKO on 6/29 or thereafter and talk to people after the film; you will know what I mean.
To learn more about the work to create a people and community-centered healhtcare system, please visit http://www.DefendHealth.org and http://www.MassCare.org/legislation and http://www.SickoCure.org
Thank you.
These comments confirm a
These comments confirm a concern I have long held - that the proactive messaging around health care reform has not taken account of the larger context - the "frame" within which we all process information. For 25 years now, the concept of government as inept and bungler has been promoted by politicans who are opposed to certain government programs. Unfortunately the Medicare Part D rollout in recent years did confirm this for many Americans.
It is also important to remember something that George Lakoff pointed out about how we "take in" information. We all have a world view and if the facts don't match that world view, they bounce off.
It therefore shouldn't be a surprise that people in the Commonwealth who are feeling beleagured financially and are already pre-disposed to think that government intervention is yet another imposition, will have a response of anger and frustration. Unfortunately, this very real emotional response clouds the intent of health care reform - that there is an genuine effort to expand access. My fear however is that the fear and confusion about the mandate, as outreach workers are describing, continues to be minimized and that it will undermine the positive aspects of health care reform. Ultimately, this will make implementation more challenging and education more crucial.
At Healthy Connections, we
At Healthy Connections, we too get a fair number of the dreaded "IMCs". More than one client has told me they're moving out of state because they think it's crazy that the government can tell somebody they must purchase health insurance or pay fines. One client confided that he was uncomfortable that our state is sliding toward communism!
Because wages are so depressed in the North Quabbin, the reality here is that most of my clients won't be penalized for not having insurance. The affordability standard was well thought out. I don't have cable, so I haven't seen the ads, but I hope they emphasize that the insurance offering must be "affordable."
If the state government isn't ready to charge the paltry $295 to employers that don't offer insurance, it's unconscionable that they'd penalize individuals for not signing onto insurance they can't afford. If this comes to pass, people are going to lose confidence in this entire project. Wasn't the individual mandate Mitt Romney's idea anyway? Can't that disappear like he did? At least for now
I do believe that through
I do believe that through understanding Health Care Reform can work. The IMC calls we recieve come to us with one of two emotions running it, fear or anger. They are both generated from the concern that after all the bills they pay per month they are going to have to pay one more. Then the issue comes that the state is even requiring this when the person is not sick and does not need the insurance.
We will calm them down as much as possible then we request all the information and then tell the person if we can assist them to apply for Commonwealth Care. At this point we will receive one of two reactions. 1.Happiness because they will be eligible for health insurance. 2. Outrage that although they are required to get insurance, and they are not eligible for the state insurance for some reason. Then outrage that after telling them there will be a waiver system we have no information as to what that waiver system looks like.
The fear and anger surrounding the individual mandate is understandable to everyone. And the mandate itself is not self explanatory and requires time and patience with all of the people who call. However education beyond, the copying and mailing segments of the law, for the larger population as a whole is definitely a needed next step.
I have been hearing from a
I have been hearing from a lot of callers right between the 300% and 400% of the federal poverty level. These callers call Commonwealth Choice excited about affordable options of health insurance; and then they call us after appalled by the premium amounts. I do explain that if there is not an affordable option of health insurance (and tell them how much that would be for them) then they can fill out a waiver.
Some of the callers are calmed down once they are informed of the waiver but many say they really want the insurance. It is not the point of the law to adhere to a mandate; the point is to have people covered.
People who call my office
People who call my office are also upset at being told how to spend their money if they feel they can't afford insurance. They are confused over the July 1st date. A patient called me this am and asked if she didn't get health coverage until September would she be fined. Yesterday another patient called and said he had gotten on the Commonwealth care program but it wasn't going to start until August so would he be fined. I explained to both that they would not be fined. They answered that is not what the TV is saying.
The self employed are another large group of people many of whom have large premiums. They have to come up each month. There is a place on the tax form to get that monies back but they just can't afford that up front.
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