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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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AbbyAbby VigneronTomHilliardRon Greiner Recent comment authors
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Ron Greiner
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Ron Greiner

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… Read more »

TomHilliard
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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.
http://www.statehealthfacts.kff.org
Click on “Payments by Enrollment Group”.

Ron Greiner
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Ron Greiner

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… Read more »

Abby
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Abby

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.

TomHilliard
Guest

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… Read more »

Ron Greiner
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Ron Greiner

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.

Ron Greiner
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Ron Greiner

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… Read more »

Abby Vigneron
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Abby Vigneron

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… Read more »

Ron Greiner
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Ron Greiner

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… Read more »

Abby Vigneron
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Abby Vigneron

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… Read more »

TomHilliard
Guest

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.

Ron Greiner
Guest
Ron Greiner

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… Read more »