So much for the overblown rhetoric about shared responsibility in healthcare reform.
Apparently the Massachusetts officials who enacted the law that has been hyped from coast to coast as the model for other state and national plans believe that only low and middle income individuals and families should carry the financial burden for resolving the healthcare crisis.
Having already relaxed requirements on the insurance giants who stand to gain tens of millions in additional profits under the plan, now we learn that the obligations on employers have been effectively eliminated in Massachusetts.
First, the Massachusetts legislature agreed, after intensive corporate lobbying, to gut the shared responsibility for businesses with over 10 employers who don't currently provide health benefits for employees to a paltry "fair share" fee of $295 per employee per year.
Even that token amount was too high for then-Gov. Mitt Romney who wanted his corporate donors to pay nothing, but whose veto of that provision was overridden.
Then, the state made it ridiculously easy for employers to evade that meager cost. All they have to do is cover one of four employees, or offer to pay a third of their employees' premium costs, no matter how bad the plans, to be exempted from the fee. And, the employer trade groups which lobbied against the fee quickly offered counseling for employers on how to avoid paying any fees.
Now, the Boston Globe reports that the state is not even bothering to collect those pitiful fees. The penalties were supposed to bring in $95 million this fiscal year and $76 million next year to help pay a portion of the public cost of the plan. Instead the state plans to collect nothing this year from employers and only $24 million next year.
That's quite a contrast with the heavy handed yoke on middle income Massachusetts residents and families who are forced to buy expensive health insurance policies or face escalating punishment.
The cheapest plan for residents of eastern Massachusetts, the main population centers, is $2,100 a year for someone in their mid-30s. For individuals over 55, that same plan costs over $4,100 a year. That's with bare bones benefits, more comprehensive plans cost more.
Add to that out-of-pocket annual deductibles of $2,000 per individual and $4,000 per family before the insurance company begins to pay for most patient services. And, if you want to choose a doctor or other provider who is not on the insurer's network list, the cost also increases.
Further, the premium fees are for the first year only. The second year, they are expected to go way up, since the law has no cost controls on rising premiums. In a May 7 commentary in the Providence Journal, JoAnn Fitzpatrick draws the appropriate parallel with the Bush Administration's Medicare drug benefit scam. "In its rush to enroll seniors," she notes, "many drug companies low-balled the initial costs -- as had been predicted -- and then raised them a year later." Bet the bank that will happen in Massachusetts as well.
If you refuse to be held hostage to the insurance companies by not buying insurance, you lose your $219 personal tax exemption. Continue to boycott the insurers and the penalty the second year goes to half the cost of the cheapest health plan, at least $1,200, an amount almost certain to rise.
Despite this growing fiasco, a lot of politicians and some advocacy groups who should know better continue to tout the Massachusetts plan as the archetype of reform. In California, for example, Gov. Arnold Schwarzenegger has proposed a plan based on the Massachusetts experience, and is lining up corporate CEOs and some legislative leaders to help him pass it.
Ultimately, the Massachusetts sham shares a lot in common with other market-based approaches to healthcare reform. The common denominator is expanding and entrenching the role of the insurance giants who are largely responsible for the current morass by transforming our nation's health from a system that delivers care to one that has become a funnel for higher profits, usually made by denying care.
It's time to stop expecting the insurers and the market will solve a crisis that continues to financially benefit them. Only one solution guarantees healthcare for everyone, ends insurance industry interference with care, and actually does share responsibility with fair share costs on employers, government, and individuals alike. It's the approach of a form of expanded Medicare for All type system taken by every other industrialized nation, represented in HR 676 in Congress or SB 840 in California.
Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee
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