POLICY/BLOGS: Interesting Mass. policy by Abby, and new blog

Promoted from the comments, regular contributor Abby writes an interesting piece about the movement in Massachusetts to get to universal insurance there via some kind of Medicaid expansion coupled with pay or play. Meanwhile definitely check out the blog written by the guy behind the Health Care for All coalition in the Bay State…..and I know what you’re thinking — they got the Superbowl Champs and the World Series winners, why should they get any more favors:

Romney_hannity_colmesWhat Mitt Romney advocates is barely relevant to the debate in Massachusetts. There’s a veto-proof Democratic majority in both houses, and it looks like Romney won’t be running for re-election. He hasn’t officially announced anything yet, but he did write an op-ed saying that he thought that Roe v. Wade should go and abortion policy should be returned to the states. Hardly a popular position in Massachusetts. I haven’t heard much from Romney advocating for Medicaid expansion. His current thing is to require people to buy stripped-down policies.

There is a coalition of groups called MassAct which is trying to expand MassHealth considerably. They are hoping to get the legislature to act, but they are organizing behind a ballot initiative. There are 4 proposals on the table.

Their goals are

*Expanded coverage for low-income individuals and families through MassHealth.*Providing assistance to middle income, working individuals and families to purchase insurance.*Offering assistance to small businesses to help them pay the premiums for their employees.*Requiring employers to either provide health coverage or pay a fee to the state.*Creating a new state quality/cost leadership council

The pay or play thing could be challenged under ERISA, but they are structuring it as a rebate for spending on healthcare, and businesses with annual payroll less than $50K are exempt. They plan to pay for this through the employer assessment and by raising the cigarette tax.

There is some talk of cutting the free care pool assessment on suburban hospitals to get them behind it. They also want to raise the reimbursement rates. The thinking is that the private patients are covering the cost of current MassHealth patients, and that this is driving up the private insurance rates forcing more people into uninsurance.

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  1. Tom,
    on your site you state: “New York uses Medicaid to pay for more stuff than most other states, to maximize the dollars from the federal government, which pays half of Medicaid costs.”
    Now this I believe. New York is very savvy at getting the American tax payer to funnel rivers of Federal tax dollars into the state. You seem to think this is just fine taking money from the Federal tax payers.
    As far as me saying that some author is a fruitcake for calling HSAs a “Rip-Off” because some banks charge $2 or $3 a month service fee is just fine. Fruitcake is not as bad as “Rip-Off.”
    At your link I couldn’t find your claim that Medicaid only costs $1,600 per year, per person in Mass. I did find that the average premium in Mass for an employers “single coverage” was $3,492 (back in 2003).
    The link is here: http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=profile&area=Massachusetts&category=Health+Costs+%26+Budgets&subcategory=Employment%2dBased+Health+Premiums&topic=Single+Coverage
    New York pays even more!!
    A 30 year old male can get HSA insurance in Lansing, MI for just $31.30 per month (that’s $375.60 per year) from the largest individual insurance carrier in America. That’s why President Bush want’s this coverage to be available in Mass and New York. This is not old costs but current premiums. I have a 64 year old lady in Lansing paying less than $200 a month and her coverage pays 100%, including Rx, after her deductible.
    Maybe you could provide the link to Medicaid insurance for a family of 4 in Mass for just $6,400 per year like you have said.

  2. It’s probably not worth carrying on a dialogue with someone who casually refers to other posters as liars and fruitcakes. But here’s the link to my source on state medicaid costs, and I encourage Ron or anyone else to examine the accuracy of the numbers I used.
    Click on “Payments by Enrollment Group”.

  3. Tom wote, “The cost (Medicaid) for a family of four in Massachussetts would be $6,460.”
    Tom is saying Medicaid only costs $1,618 a year, per person, in Mass. This is not true.
    Abby you wrote, ” His blog is great. Interestingly enough, given Ron Greiner’s evangelism above, the entry for August 15 is dedicated to discussing a NY Times article about why HSAs are a rip off.”
    I read his blog and this guy is a fruitcake. Sure some banks charge a $2 or $3 a month for their HSA account, but these guys are rookies. He should have been more fair and balanced. He could of said that Ron has been enrolling MSAs and HSAs since the very first day and has never charged a client a dollar to open a tax free account. Ron’s HSA is absolutely FREE. Which means Ron has never made a commission ever on an HSA. To this day Ron, has never made a penny on an HSA.
    Get the original tax free HSA and enroll for free with no monthly fees. Yes, you get a beautiful HSA VISA card and checks. Plus, total online access to your account with a mutual fund option for the possibility of a higher return.
    Don’t pay $6,460 a year for health insurance (Tom’s lie), that’s way too much. Many families have HSA health insurance for under $2,000 a year, plus they grow their savings in their FREE HSA with no enrollment fees or monthly service costs. Like Abby and the New York Times say, “HSAs with a monthly fees are a rip off, so get the original HSA which is still FREE.
    Thank you Abby for suggesting people enroll in our FREE tax free HSA. Maybe you should inform your blogging buddy, he should know about the FREE HSA. But of course we refuse to go to Mass, a controlled monopoly state, but we are in more states than any other insurance company in America with the security of low cost individual HSA health insurance. Speaker Hastert says the first HSA was enrolled in his district. Of course that HSA was a FREE one.
    The New York Times is hiring young women and putting them on health insurance that if they get ovarian cancer and can’t work they are put to COBRA for insurance termination. So don’t listen to the NY Times about health insurance anymore. I shudder to think of all the New York Time’s employees who have been terminated on their health insurance since WW 2. Maybe Tom can give us a breakdown on how many employees were uninsurable and their lives were distroyed. Now that’s a “real” rip off.

  4. Tom,
    I don’t know if anyone is pushing a bill like that, but I suggest that you e-mail John McDonough of Health Care for All. He used to be a member of the legislature himself, so he understands how legislation gets done, and he’s also taught at Brandeis. He’s incredibly accessible. His e-mail is mcdonough AT hcfama dot org
    His blog is great. Interestingly enough, given Ron Greiner’s evangelism above, the entry for August 15 is dedicated to discussing a NY Times article about why HSAs are a rip off.

  5. FYI, here are the latest per-enrollee numbers on Medicaid from Kaiser Foundation. They’re from 2001.
    U.S.: 4,011
    Michigan: $3,717
    Massachussetts: $5,141
    New York: $7,817
    Ron’s source on New York State is the NY Times Medicaid fraud story, which imputed a 10% annual increase from 2001 to 2004. As you can see, the Medicaid cost in Michigan for four people would be $14,800. And the cost for a family of four (if there are no elderly or disabled members) would be $5,170. The cost for a family of four in Massachussetts would be $6,460.
    But this discussion is irrelevant, since anyone with an HSA is, by definition, underinsured. The debate in Massachussetts is how to provide full insurance for its residents.
    Abby, if Dunkin Donuts objects to paying a pay-or-play tax for its employees who are on Medicaid, the taxpayers should know how many Dunkin Donuts employees receive Medicaid. Is anybody pushing a bill to this effect?

  6. Here is what you said//
    For the purposes of the section, “adjusted payroll” shall mean the annual payroll of an employer minus $50,000. An employer shall be allowed a credit against its assessment equal to the employer’s expenses for employee health insurance benefits in the commonwealth that are or would be deductible as medical care under federal tax law.//
    It doesn’t say capped at 50K Abby.

  7. Abby,
    You said ////
    So, if a small employer has 8 part time employees with annual earnings collectively of $50K, the additional earnings of the owners of $100,000 will be taxed as I said. You then say it’s capped on the first $50K of payroll – which isn’t true, come on.
    Let’s pretend you actually knew what you were talking about. Under your goofy plan employers might as well spend as much as they can on insurance because it’s an offset to taxation. It sounds like Blue Cross wrote your taxation plan. If you don’t spend it to Blue Cross the state will take it away from you in taxation and give it to Blue Cross anyway.
    HSA Qualifing Health Insurance is giving more options and becoming much cheaper.
    A 30 year old couple and 2 children can get HSA Qualifying family health insurance for $1,961.88 annually in the 48901 zip code (Lansing). Starting this month new options for this coverage are approved by the state. Drop the lifetime maximum down to only $2 million, per person, and some other changes and this family can get HSA Qualifying coverage for only $95.72 per month. Plus, we now have options where the deductible is only $100 for accidents.
    Hey Tax Payers, don’t pay $42,400 a year for over priced Medicaid insurance when families can get HSA insurance for $95 a month in the free and open market. Then these people grow their savings in their tax free HSA with a mutual fund option.
    I’m still going to push clients to spend a bit more and have the $8 million lifetime max, per person, if they have children. Who knows what it will cost in 20 years to get sick. This is from the big dog in individual health insurance in America, which is in 43 states. I know we were the first with MSAs and HSAs in the USA. The rumor is we wrote the first health insurance in America in 1913. So we have some experience. The goal is to give the clients value.
    The best tax cut is no taxes
    And it’s TIME for your HSA.
    Governor Bush just gave Florida state employees the tax free HSA option, what a Governor. Florida is a leader and the first state to do so.
    Vote Republican for the Ownership Society

  8. Ron,
    you misread the statute. How do you define make $100,000? Is that their total payroll? Because, if it is, I’m assuming that they have fewer than 100 employees. The payroll rate is 5%. The adjusted payroll rate takes out the first $50,000. So we’re talking about 5% of $50,000. That’s $2,500. If they’re spending $2,000 on healthcare for themselves, but not on any of their minimum wage employees, then contributing $500 to the mass health program doesn’t seem unfair to me.
    Why are you citing New York’s numbers, Ron? Why don’t you cite numbers from Massachusetts?
    And I don’t think you’re being straight with me on the cost of that HSA in Michigan. Isn’t it $2,000 for the HSA plus $130 per month for catastrophic coverage? That comes out to $3560–and if it’s all deductible under Federal tax law, then you wouldn’t owe any extra. (Maybe we should make them cover their employees first.)

  9. Abby,
    Who you jivin with this cosmic debri?
    Let’s see how this would work. A 30 year old couple and two children can get tax free HSA health insurance in Lansing, MI for under $2,000 per year for the entire family. If the couple made $100,000 a year from their small business (Dunkin Donuts) they would owe $7,000 in extra Mass payroll taxes. They may credit the $2,000 paid on their family’s insurance, so they would only owe an additional $5,000 to the state instead of putting it in their own tax free HSA!!!!!!!!
    Plus, if their children become diagnosed they will never be able to leave the state of Mass because their insurance will be terminated and they will be uninsurable. Trapped in Mass for life, that’s pitiful.
    Boston and New York are ripping off the rest of the American tax payers because Medicaid and Medicare cost so much there (It’s a mountain of money), with the majority of the funds coming from the Federal government. Then they turn around and say they are not getting enough, like you do.
    Look at the numbers Abby, it’s so simple. Medicaid costs $10,600 a year, per person, in New York. That’s $42,400 a year for the above family of 4, that really only costs $2,000 a year in the free and open market. The poor people don’t get the money, it all goes to politically connected insurance companies with government contracts and lobbists up the wazoo at your state capital, get real. You say you are a concerned citizen, come on. You sound like your on the payroll of Blue Cross of Mass. Remember when Senator John Kerry kept sayin in the debates that he had Blue Cross, over and over? That made me sick. Please Abby, consider the poor broke uninsured children, just for once in your life, and not the monopolist insurance companies that feed off of our tax dollars like parasites, trying to kill the host.
    Governor Jeb Bush said, “Floridians will use their tax free HSA balances wisely.” President Bush said, “Get low cost HSA health insurance and combine that with a tax free HSA and you have yourself affordable healthcare.” President Ronald Reagan should have said, “Trickle Down (TD) saved by citizens in their tax free HSA is the conclusion of Reaganomics.” It’s basically the Ownership Society. I mean, money that is never taxed will last longer in Retirement, that’s for sure.
    Give tax freedom a chance Abby.

  10. Ron,
    I don’t have all of that data. I am not a policy expert, just a concerned citizen.
    1.) I don’t know hoe MassHealth compares to New York’s Medicaid.
    2.) You have all the data for the cost differentials between Michigan and Florida. It must be easy for you to pull up the Massachusetts numbers.
    3.) If by “controlled monopoly like New York” you’re referring to the fact that both states forbid medical underwriting, then I have to say that I see that as a feature, not a bug. Of course that system doesn’t work very well when you don’t have universal insurance, and that’s what these folks are trying to rectify.
    4.) I don’t want to condone wasteful practices in Medicare, but Masschusetts pays rather a lot in Federal taxes–more than we get back, unlike those free-market paradises of the Deep South.
    5.) It would be really awful to get kicked off of your insurance when you’re sick, but in Mass if you are on a group plan and you sign up for individual coverage within 60 days, the insurance companies can not impose any waiting period on pre-existing conditions. Even if you were uninsured for a long time, I think that the waiting period is only 3 months. I know that must make your insurance salesman’s heart stop dead, but that’s the system we have.
    Thanks, but I think it was just a one-time deal, and I’m cringing at how poorly written it is.
    Who’s trying to kill it?
    1.) In the past the tobacco industry opposed unsuccesfully increases in the tobacco tax. I doubt that they have much clout, but they’re probably against it. Big tobacco may not care though. They might just want to focus their efforts on growing markets overseas. I don’t know.
    2.) The biggest opposition will be from employers who don’t currently cover their employees, e.g., the Dunkin Donuts of the world. Large employers who provide no insurance to the bulk of their employees are the ones who will hate it.
    Here’s the relevant language:
    “Chapter 6A of the General Laws is hereby amended by inserting after section 16H the following section:
    “Section 16I. The Secretary of Health and Human Services shall implement an Affordable Health Care Fair Share assessment. Employers with more than 100 workers shall be assessed at the rate of 7 per cent of their adjusted payroll. Employers with 100 or fewer workers shall be assessed at the rate of 5 per cent of their adjusted payroll. For the purposes of the section, “adjusted payroll” shall mean the annual payroll of an employer minus $50,000. An employer shall be allowed a credit against its assessment equal to the employer’s expenses for employee health insurance benefits in the commonwealth that are or would be deductible as medical care under federal tax law. The credit shall not reduce an employer’s assessment below zero, and shall not entitle an employer to a refund.”
    They are hoping to buy off the health insurers and purchasers of healthcare by repealing the uncompensated care surcharge. They are also proposing that the state provide reinsurance for the most costly cases.
    Suburban hospitals also pay into the uncompensated care pool, and their surcharge would be reduced under at least one of the proposals.
    I think that the doctors will be on board if the medicaid payments go up to Medicare rates.
    The coalition behind it is a good group of people. I know about it primarily through the Greater Boston Interfaith Organization which is organizing churches. These range from evangelicals and pentecostals to tony Episcopalians and wealthy Reform Jews. The SEIU is on board as is the Massachusetts Medical Society. HCFA has a list of campaign leaders on their website.
    If this passes, it should cover about 80% of the 500,000 or so uninsured. It is definitely an incremental solution.

  11. Congrats on your promotion! I’m looking forward to your posts, which I know will be insightful. Don’t forget to ask Matt about salary and benefits…
    Who’s trying to kill the MassHealth expansion? If it’s as bold and promising as you suggest, there’s got to a lobby out gunning for it.

  12. Abby,
    How much does Mass Medicaid cost? Are they charging tax payers over $10,000 a year, per person, like New York, another Democratic state knee deep in corruption.
    Does Mass SCHIP program terminate poor sick children on their 19th birthday like all the other states?
    Mass is a controlled monopoly in health insurance. The largest individual insurance company in America is in 43 states but not Mass or New York.
    How much is paid to Medicare HMO’s in Boston per year by federal tax payers?
    Get your health insurance from the government and it will always cost tax payers 10 times more than the free and open market, it’s pathetic.
    Please Abby, inform us how expensive is Mass Medicaid, that’s paid with Federal tax payer funds?