How is forced health insurance working out in Massachusetts?
So, the house has narrowly passed a health care bill that will force the uninsured to buy insurance. I’m one of those 42 million people who doesn’t have health insurance because my employer doesn’t offer it and individual coverage here, which amounts to picking one of three blue cross plans, starts at 10% of my income…if I buy the cheapest plan that has a $5,000 deductible. Otherwise, it’s more like 20% of what I make in a year. So far, as someone fairly young and fairly healthy, playing the odds has worked in my favor given I’ve never yet needed to spend more than $6500/year on health expenses out of pocket (being as I’d be paying monthly premiums plus $5000 before a penny got covered).
Now that this bill has passed, like millions of other people I’m curious how this is all going to work out. Rumor has it that forcing people to get coverage will work somewhat like the law enacted in Massachusetts, so let’s talk about that.
The state of MA offers a calculator to determine how much a person can afford for coverage - at my income level a person in MA could afford a premium that costs 1/3rd as much as the very cheapest insurance plans offered in my state. (I’d get insurance voluntarily in a heartbeat at those prices) What has happened to similar Massachusetts residents after an individual knows how much they can afford? It’s all very well for the state to say you can afford $50 a month, but are they actually able to get coverage for the prices they can afford according to the state? What is being done in practice to help people afford the insurance that they’re required to have?
If I remember correctly, you just have to say you had it at all times in the past year but you still need to be able to prove it in the rather unlikely event of an audit.
Another instance of a highly effective law.
The HONOR SYSTEM! :smack:
ETA: This isn’t a commentary on UHC, or required insurance, just ineffective governments. I hate, more than anything, a program that has the potential to be effective and improve quality of life, be bogged down by terrible planning or implementation.
agreed. but remember, Gov’t is in this for the long-term. Right now this is new. People are always suspicious and concerned about anything new. 10 years from now it everyone will be used to it and some study will show that honor-system reporting is not as effective as hoped. So the law will be quietly changed. Think seatbelts in cars, advertising for cigs, many Gov’t-led changes in society. If Gov’t goes too fast, they have found that changes are sometimes reversible in the first few years. After some new idea captures the public imagination, improvements to the old ideas will be implemented.
Not honor system. Your health insurance provider sends you documentation for the times that you’re covered. You have to include them with your tax forms.
In the end the “fairness” to you as a bottom wage tier young person is kind of irrelevant. Demographically you don’t vote and will cost them relatively little as you tend to be healthy. You are a non-entity. They will get the the maximum they can out of you within limits and move on.
The whole point of public health care reform (demographically) is that the under the current model the projected near and long term care cost for people moving into their “golden years” is an absolute budget backbreaker. The current free market delivery model is wildly inefficient and expensive in delivering medical care to a target population of elders who are likely to suffer from myriad chronic medical conditions associated with aging.
The cost the US pays for medical services is almost exactly the opposite of what you would expect to see in nominally free market system because the system cannot (in real world terms) conform to the normal free market supply and demand curves. The demand for medical services is relatively inflexible. If you get sick you can’t switch to lower cost doctor or drug, you do without or get services as a non-paying indigent patient which are very expensive for the system to deliver.
The cost to deliver medical services in the US (or anywhere) is not subject to the usual supply and demand market rules where you would expect more service providers to rapidly enter the market due to various (some quite practical and some fairly self interested) entry barriers. This has left to proliferation of various gatekeepers and middle men controlling access to, and delivery of, services that makes an already expensive system even more expensive.
The bottom line is that for the target elderly population the US care delivery system combines the worst aspects of a capitalist and socialist model with none of the benefits. Other modern industrialized nations have realized this problem and have moved health services into the category of universal care models. On a case by case basis you may not get the acme of care available in some sectors of the US model, but you will get care. The current model is utterly non-sustainable and trying to put band-aids on it is only going to make the problem worse.
So, I take it no one knows what’s happening in MA, and just wants to rant some more about the pros and cons of universial health care in general? sigh.
with their state income taxes each year along with documentation from their insurance company showing that they had insurance that met the requirements for the previous year.
You can see explicitly how it works from that form, but the basic point is that there are a number of ways to get exemptions, but if you cannot meet them, you must pay a penalty, the amount of which is outlined here:
The penalty is between 200 and 1,000 dollars per year and is calculated based upon how much it would have cost you to get the insurance you’re supposed to have gotten.
If you cannot afford insurance, you likely meet the criteria for subsidized insurance from the state, as outlined here:
The basics are: free health insurance for people below 1.5 x the federal poverty limit or children of people below 3 x the federal poverty limit and substantial subsidies for people between 1.5 x and 3 x the federal poverty limit. There is a state agency whose job it is is to help you get your subsidized health insurance if you qualify for it, and their website is here:
Oh come on, the whole income tax system works on the same principal. They don’t check every single taxpayer’s return to make sure that all of your receipts for donation, the business mileage on your car, and other expenses are valid. That’s what audits are for. These days they can match up W2s with your returns, but historically it was a manual process. Auditing every single return to make sure that every detail is correct would cost more than it would raise in revenue. That would be govt inefficiency.
I hate this whining that everything the govt does is inefficient.
ETA: I lost my wallet recently and I got my replacement driver’s license faster than I got my replacement credit cards.
So do I. Imperfect it may be; so is everything. But no way is it inefficient in all that it does.
Medicare has worked extremely well in the case of my elderly folks. And when my dad died, we had to call a number of agencies to inform them, get paperwork, change things, etc. Soc Sec/Medicare was the easiest and quickest one. Painless.
You want to know who was a total, mixed-up PITA? STRS. But it was a California state agency, after all.
The article seems to indicate that the real problem is the underinsured. It’s like those people who only get minimum coverage for car insurance, then hit you. It doesn’t help you much if at all, and since they are so poor you can’t even sue them or if you did you wouldn’t be able to collect.
That is a very key issue, as long as you can “Be insured” and not get coverage (example: huge deductable) to pay your bills then it’s in effect, a tax on people without no return.
It’s like having to spend down all your assets so you can be poor enough to qualify for medicaid and such.