Universal Health Insurance

Yesterday, I attended a meeting of very committed and smart individuals dedicated to making Massachusetts Universal Health Insurance Reform Law work and work as intended - to provide access to health insurance to those in our state who are currently without it.

Health Care For All, which has been a major force in advocating for the consumer in this process, estimates that already the number of uninsured folks who have been enrolled in affordable and good quality health insurance plans since the law was signed 4/12/06 total more than 100,000: 58,000 new MassHealth enrollees since 7/1/06 and 47,000 enrollees in Commonwealth Care. (Commonwealth Care is a new state program that offers free or reduced cost insurance for adults 19 or older who meet certain income guidelines.)

But some big decisions loom, and what happens could greatly impact home care agencies. Home care agencies employ many paraprofessional workers (home health aides and homemakers) whose salaries are a product of what government payors (Medicare and Medicaid) will pay for a home visit. Although home care agencies almost universally offer health insurance to their workers, many aides and homemakers "opt out" because the premiums would consume too much in their weekly paycheck. (A $1200 a month family plan subsidized by the employer at 50% would costs the aide $600 a month.)

With the deadline for the individual mandate (at which point most citizens will be required to have insurance) fast approaching (July 1, 2007). decisions have to made. At this point, although many of these workers are income-qualified to access subsidized care through Commonwealth Care, they are at present excluded because their workplace offers insurance. The smart people referenced above, who are working to influence decision-making of the implementation body The Connector, are considering these issues with an eye toward possible changes. Nothing has officially been endorsed, however in the mix are:

• a process to waive the exclusion from CC for certain workers in companies that offer insurance (if the insurance is too costly or does not meet "credible coverage" guidelines),
• advocating for premium support to help workers to afford to opt-in to an employer-sponsored plan,
• and, most drastically, delaying the insurance mandate for certain individuals (according to income, job status or other criteria).

All of these possible changes or mid-course corrections have domino consequences to the delicate balancing act that is health care reform. On the employer side, the mandate holds the possibility that workers who previously opted out (some in favor of higher hourly pay) now will seek coverage. (A good thing, many believe). But our home care agencies have little resources to find revenue to cover drastic increases in the employer cost of providing insurance. Government payors set our rates and we can't raise them at wil - even to cover new government mandates.

Which way all this will go is too early to say. The bottom line: our insurance system is costly and complex and so is the health reform act. That doesn't mean it wasn't a good thing, because it was. It's just going to take a lot of very smart and committed people to make it all work.