What do we mean by "universal coverage"?

It's hard to really say if the health insurance mandate and the focus on getting people covered are playing a part in the deterioration of health insurance benefits. I have seen this trend for the last several years. What seems to really have taken off recently are plans with deductibles (often very high) and health savings accounts. Both of these deter people from seeking medical care and are being forced upon people without regard to their resources. In most cases, the only resources being considered are those of the employer who is choosing the plan. Business must always focus on the bottom line - that's part of being a business. It doesn't make sense to me that decisions about a families health insurance and ultimately the families health, should rest with a business. It's not what business is about.

Included in the people who are considered "covered by their employer" are self-employed people who have a subsidy for their private insurance from the Insurance Partnership (IP). These are responsible working people who pay more every year as their premuims go higher and higher, while their IP subsidy remains fixed.

I have clients who pay premiums of $600 a month or more for an individual policy. They may get $150/month subsisdy from IP. If they qualify for IP, they also qualify for Commonwealth Care. If they were uninsured, instead of "doing the right thing" and paying for insurance, they would be paying no more than $120 a month or so for Commonweath Care coverage.

Their premiums are now increasing to the point where they will be forced to drop the coverage, and they will be (a) vulnerable as a result of being uninsured and (b) further penalized under the law!

It seems totally unfair that under health care reform they are essentially being punished for being responsible in the first place.

I too can attest to what your saying Brian, and agree with your observations. My sense is that "universal" is misleading when there are so many disparities still facing our residents who are desperately trying to comply. Transportation, lack of providers, and the lack of availibilty of providers willing to accept the MCO'S and/or new patients at all are still ongoing issues. All that combined with what you are seeing seems very unsettling in my eyes. The cost of many other things are climbing but, people's wages are not many people I encounter live paycheck to paycheck or are beginning to exist on plastic, losing homes, and going into debt. Access and affordabilty will be what makes or brakes "universal health care" and beyond that the coverage they do or don't have will open up many other interesting issues to come.

Be thankful you have an employer who pays a portion of your health insurance. I have many people who have come to me who only qualify for Choice with a premium of $850+ per month per person. Surely these small employers as are found in more rural areas (cottage industries) are giving us the new uninsured who will be penalized the heaviest by "universal coverage"!

my current employer pays 66% of medical insurance policy which leaves employees with $418 bill a month for health insurance. Mind you $20 copays and $3,000 deductible per person $7,500 deductible for family plans before insurance can cover services. Yet MassHealth reviewed this insurance and deemed it credible coverage. It seems like the middle class working american like myself are the ones who will pay the highest price or end up getting penalized which at this point seems more affordable. But next year the penalty will not be as affordable.

PS - Brian -

I'm Community Partners' HR person, and just got a letter from the Connector that seems to be telling me I can avoid the Fare Share Assessment on employers if I offer to pay at least 33% toward my full time employees 'individual health plan.' It doesn't say that plan needs to be 'creditable.' In fact it warns me that my employees 'may still be subject to the tax penalty' if they take my [less than creditable] insurance offering.

Is this even close to fair?? As an employer, I can offer a high deductible, no drug coverage plan and as long as I offer to pay 33% of the individual premium, I do not have to pay my 'Fair Share' - even if the coverage is so bad no one takes it - even if someone, wanting to have at least some coverage, takes it and STILL loses his/her personal tax exemption. Seems I can save a lot of money by offering to pay 33% of a poor plan, just as long as I make sure I've set up a section 125 plan for before tax payment of premiums (which may save me more than it costs anyway, given that I save 7.65% off of my FICA on every dollar my employees put through that plan).

Well, the letter does say 'If you want to help your employees' meet their creditable coverage requirement, you 'should' make sure the coverage you offer is creditable. I guess that 'should' is supposed to carry more weight than all the economic incentive to do exactly the opposite.

One more PS - my trusty CP co-workers tell me that employers are only exempt from offering coverage that is creditable for this first year. After January 1, 2009 I would have to offer coverage that is creditable to avoid paying my 'Fair Share.' Knowing that I will need to offer creditable coverage in the future seems one thing that might mitigate my financial incentive to offer lousy coverage now - odd that's not mentioned in the letter I got.

Danna, I hear what you are saying but it has been the role of the employer for many many years to "take care of their employees" and health insurance has been a huge part of that. Those same businesses who now are on the short end because of rising health care costs were the benefactors of the past when they chose to forego raises for their employees by adding insurance. They cannot have it both ways!

I had thought that the issue of extrordinary up front costs was addressed in the mandate. All I have been seeing lately is "coverage" period. If the minimum standards for "credible" coverage have been eliminated that is the issue we need to address. If they are on the books we need to look at them and make sure we don't have people paying for coverage that doesn't fit the guideline. I, personally, have come across a company that offfers insurance to all of its workers. The carrier name is nationally recognized. It was only when one of the workers was diagnosed with cancer that we found out - the 1500.00 and 7500.00 figures were not copays and out of pocket - THEY WERE THE TOTAL ANNUAL PAYOUT. By putting the mandate in place we also opened the door to corrupt companies who just want to make a fast buck. Between the employer and the worker premiums the policy I came across is almost 100% covered. I feel it is imperative that we look closely at exactly what our consumers are actually getting for their money. We have "lemon" laws for CARS - why can't we do the same for healthcare insurance?

You used the word 'brakes' instead of 'breaks', but in this instance it is entirely appropriate within the context of what is - and is not - happening in our fair Bay State, under the cudgel of the draconian 'health' reform law.
Though this miserable, self-serving law (Chapter 58) was written by corporate toadies and attorneys affiliated with the 'health' insurance industry, the resulting spin in the press would convince the gullible that it was thoughtfully crafted by smart people, who perhaps fancied themselves visionaries.
Or so it seems.

Funny, there's zero thought being given to cost controls. Or maybe that's intentional: a nice 10% per annum increase suits the greedy players just fine, now, doesn't it?

So maybe later they can put on the brakes, eh?

One of the powerful things I get from Brian's post and from talking to him is the understanding that many small and middle employers want to do right by their employees but are facing difficult financial choices. His question is crucial for year two of health care reform implementation - how to discuss and evaluate the appropriate use of health care by people who are insured? It is not enough to claim success by how many people are carrying around a plastic health card in their pocket. That is the first step but ultimately it is about getting quality and affordable services that are needed. Advocates and policy makers have begun to focus on this; 2008 will be the year of Quality and Cost. One question to ask based on Brian's observations is "did we sacrifice quality and cost for previously insured folks" in an effort to cover more residents of the Commonwealth?" If so, in what situations did that occur and what does that mean practically and from a policy perspective?