Opinion: Time for the affordability discussion
By ROBERT E. GIBBONS
As Massachusetts embarks on what is inarguably the most ambitious health care reform effort in the nation, each step of the process merits close attention. Every Massachusetts business, individual, hospital, and community has a stake in the game.
Last month, the Commonwealth Health Insurance Connector Authority tackled a major component of the reform law - deciding what qualifies as the minimum level of insurance that everyone 18 and older must have. This month comes a decision at the very heart of the reform effort: how to determine if the new insurance products are affordable. In July, everyone in the state must have insurance.
The March vote on the minimum standards - known as Minimum Creditable Coverage (MCC) - generated discussion and general affirmation among the members of the Massachusetts Hospital Association, which represents each acute care hospital in the state as well as most specialty hospitals, among others.
The Connector's MCC vote requires that every health insurance product offered in Massachusetts include prescription drug coverage, but the Connector delayed implementation of that requirement from July of this year to January 2009. The delay gives businesses and their employees time to transition, which we think is reasonable given the daunting challenges of implementing the reform law.
We feel the next decision point - what's affordable - must also meet the reasonable standard. Under the reform effort, you must buy insurance if it is determined to be affordable for you. The MCC guidelines have determined what that insurance must look like. Now, the Connector must decide what is and isn't affordable.
Affordability matters to hospitals for several reasons. First, we want our patients to afford the insurance products offered them. Affordable insurance will encourage those who delay care to receive it sooner, and prompt care can make a big difference in the quality and cost of a person's medical treatment.
Affordable coverage also will help minimize the often difficult need for hospitals to capture payments from uninsured people, who often have legitimate reasons for not being able to pay their bills. Secondly, hospitals care about affordability because they are - aside from being caregivers - employers of more than 160,000 men and women. We want to ensure that our workers can get coverage they can afford.
Varying proposals are already circulating on how to address the affordability issue. The ACT!! Coalition, of which MHA is a partner, has put forward a plan that would cap annual health care premium payments for someone earning up to 400 percent of the federal poverty level (about $41,000) at five percent of their income (or $2,050). And there are concerns that the relatively low-premium plans the Connector has approved come at the expense of high deductibles, high co-payments, and high co-insurance payments.
The affordability debate must be as vigorous and transparent as the ongoing debate on how to keep down overall health care costs. While hospitals seek ways to manage resources better, not just to reduce costs, but to improve patient care, we must also require transparency about the true costs of the insurance being offered. Ensuring that the new insurance products are affordable and offer sound benefits are keys to reform's success.
Robert E. Gibbons is interim president & CEO of the Massachusetts Hospital Association.
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