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October 30, 2005

Initial reactions to House health care plan

Here's my quick-n-dirty first take on the House's plan, to be unveiled tomorrow am. See this post for the sections to which I'm referring.

A. The expansion of MassHealth is good: It's the strategy for which we had hoped in expanding access to low-income folks -- exactly the same as the Health Access and Affordability Act. Restoration of dental services cut in 2002 is also important.

B. This creates a "purchasing mechanism" for individuals and small business to buy insurance. Now, if this creates a "pool" by which the buying power of the state is leveraged to lower rates, that's good. I'm not clear on that from the language, however.

C. "Commonwealth Care": It's a subsidized insurance program for those who are too "rich" for MassHealth (our Medicaid program) but still under 300% of poverty level. Sliding scale assistance.

D. There's that pesky personal mandate again. "Individuals for whom there are not affordable products [Who decides what's "affordable" and for what income level?] available will not be penalized." Uhh... that's good, I guess... but if there is an "affordable" product for you, you still have to pay a "penalty" based on what you would have to pay.

Look, I understand the reason why you want folks to pay in: Because otherwise the uninsured eventually end up in the hospital, and somebody pays for that care. Still, it's going to be controversial.

E. This is a good part of the plan, and one that I hope gets significant play: Currently businesses that do pay insurance have to pay into the Uncompensated Care Pool, while businesses that don't, apparently don't have to pay. In other words, there's no disincentive for not insuring your workers, while you have to pay a surcharge if you do. Obviously that's wrong, and needs to be fixed. This is a good deal for all businesses that insure their workers, and tough on those who don't. That's a positive incentive, it seems to me.

F. Addresses racial and ethnic health disparities. A-OK by me.

G. I have to say I'm pretty ignorant about the aspects that address hospital billing, though they're doubtless critical.

H. Apparently there's no extra ciggie tax or alcohol tax. The money comes from the employer assessment and tobacco settlement funds. Is this realistic?

Posted by Charley on the MTA at 06:10 PM in Health Care, Massachusetts | Permalink

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Comments

It's easy to dip into tobacco and alcohol taxes for everything -- but they can only go so high relative to (a) neighboring states, (b) what is fair, and (c) eventually they'll get so high that increasing them will result in less tax revenue.

I'm not worried about (c), particularly for tobacco. As a nonsmoker, I'd be happy to pay more taxes if the going price of a pack of cigarettes was $20 and fewer than 2% of MA residents smoked. I don't know how high (b) should be. One way to consider it is to measure the cost differences in health care to smokers and non-smokers, and use that as a metric. I do know that our neighboring states, perhaps with the exception of NH, are also playing the game of increasing taxes on tobacco (don't know about alcohol), so that isn't as big a concern.


If they were to ever consider "sin" taxes based on consumption that lowers the health of consumers (and thereby increases health care costs), I'd also recomment throwing on a bit of gasoline tax. After all, cars throw out all kinds of air pollution and are a far more dangerous form of travel than walking, cycling, bussing, Ting, commuter railing, etc.

Posted by: stomv | Oct 31, 2005 6:07:31 AM

What about a baseline for the healthcare reform debate being:
Should access to affordable quality healthcare be employer/employment based?
The U.S. is the only major industrialized nation that has such a high percentage of uninsured and underinsured and tenuously insured. And the U.S is the only major industrialized nation that makes quality healthcare dependant on your employment status. Coincidence?
Of all of the proposals being seriously considered right now, all in some way confirm employer based healthcare as the model to ride into the sunset with. Is just the way that it is meant to be? We've re-jiggered the employer based model for 50 years, and you see where it's gotten us. Is that good or bad? Will more re-jiggering finally do the trick?
If you think that it is good. And that we should remain for generations to come an employer based system, I would encourage you to support the ACT/Affordability Access proposal. By, for the first time ever, codifying by law the requirement that it is your job, rather than yourself, that determines your healthcare decisions (as opposed to the current market-based system) this proposal will move our healthcare system the most diametrically opposite of all other major industrialized nations.
Good or bad?

Posted by: fair deal | Oct 31, 2005 12:32:04 PM

The house health care plan seems like a great idea. I hope it can offer to more health coverage and better benefits to all.

Posted by: California Health Insurance | Nov 8, 2005 1:30:25 PM

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