Health Care Proposal Comparison

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					         GBIO Health Care Proposal Comparison
                          Governor Romney’s                                    Senator                          GBIO-supported Health
                                Plan                                         Travaglini’s                       Access & Affordability
                                                                                Plan                                     Act
Restoration of Cuts   •   No restorations.                               •   Restoration of $25 million     •    Restoration of MassHealth for documented
                                                                             for public health prevention        immigrants.
                                                                             programs.                      •    Restoration of dental and eyeglassses as
                                                                                                                 benefits for MassHealth participants.
                      •   Create a new, publicly-funded “Safety Net      •   No change                      •    Expand MassHealth eligibility requirements
                          Care” managed care program to insure                                                   for individuals and parents to 200% of
   Coverage of            individuals and families who don’t qualify                                             poverty and for children to 300% of poverty
Uninsured Working         for Medicaid from 0-300% of poverty.                                                   so that they can take advantage of the full
  Poor (Families      •   Eligibility rules, premiums, copayments and                                            benefits of the MassHealth program.
                          benefit limitations have not been decided                                         •    Provide premium assistance for adults
between 133-300%          upon. This bill is expected to be filed late                                           between 200% -300% poverty who purchase
   Poverty and            this summer.                                                                           private insurance.
                      •   The Governor has said that charges will be
Individuals from 0-       on a sliding scale, but no information is
  200% poverty)           available. Lack of funding will likely lead
                          to substantial costs for recipients and/or
                          restricted benefits.
  Assistance for      •   No Change.                                     •   No Change.                     •    Provide premium assistance (on a sliding
                                                                                                                 scale) for adults and families between 300-
moderate-income                                                                                                  400% poverty who purchase private
people purchasing                                                                                                insurance.
private insurance
  (300%-400%
    poverty)




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                         •   Create a new insurance product called         •   Create a “re-insurance”         •   Create a “re-insurance” program that takes
                             “Commonwealth Care” that can be                   program that takes the most         the most expensive cases out of the
   Affordability of          purchased by individuals, small businesses,       expensive cases out of the          individual/small group market. Firms with
    premiums for             and individuals who work at large                 individual/small group              up to 50 workers are eligible.
individuals and small        businesses that don’t provide health              market. Firms with up to 5      •   This program will reduce the cost of
                             insurance.                                        workers are eligible.               insurance for individuals and small
      business.          •   “Commonwealth Care” is a stripped-down        •   This program will reduce            businesses by as much as 30%, without
                             insurance product that the Governor says          the cost of insurance for           reducing the quality of coverage or
                             may cost on average $200/month for                individuals and very small          increasing co-pays/deductibles.
                             individual coverage, and $500/month for           businesses, without reducing    •   No creation of stripped-down insurance
                             families. Coverage for older people will be       the quality of coverage or          products.
                             more expensive.                                   increasing co-                  •   Expands Insurance Partnership Program
                         •   Deductibles will range from $250 to $1000,        pays/deductibles.                   which subsidizes small businesses that offer
                             and co-pays will go from $20 to $40 per       •   Similar to the Governor’s           health coverage to low-income employees.
                             office visit.                                     plan, this proposal permits
                         •   Coverage will be more limited than existing       the creation of stripped-
                             insurance products (no firm details exist).       down health insurance
                                                                               products that can be
                                                                               purchased more cheaply.
                                                                           •   Expands Insurance
                                                                               Partnership Program which
                                                                               subsidizes small businesses
                                                                               that offer health coverage to
                                                                               low-income employees.
Fair re-imbursements     •   No Change.                                    •   Increase Medicaid               •   Increase Medicaid reimbursements to
                                                                               reimbursements this year to         hospitals and physicians each year to reach
    to hospitals to                                                            hospitals and physicians by         goal of Medicare payment levels.
 prevent cost shifting                                                         $116 million/year.
  to private payers.                                                       •   Rates increased each year to
                                                                               reach goal of Medicare
                                                                               payment levels.




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                      •   No employer responsibility.                   •   Charge companies with over     •   Require employers who do not provide
                      •   Employers who offer Commonwealth Care             50 employees a fee for each        health insurance for their employees to pay
    Employer              will be permitted to display a sticker.           employee that uses the Free        an assessment, based on the size of the
   Responsibility                                                           Care Pool, if that employee        company’s payroll. Small, low-payroll firms
                                                                            is not offered coverage            would be exempt.
                                                                            (called a “free-rider
                                                                            surcharge”).
                                                                        •   (Surcharge also imposed on
                                                                            Pool use by a worker over
                                                                            300% of the poverty level
                                                                            who turns down offered
                                                                            coverage).
 Racial and Ethnic    •   No provisions.                                •   Community Health Worker        •   Community Health Worker program sends
                                                                            program sends certified            certified community-based health workers to
 Health Disparities                                                         community-based health             assist in health promotion and enrollment.
                                                                            workers to assist in health
                                                                            promotion and enrollment.
      Quality         •   No provisions.                                •   New board to post              •   Create quality control board that can
                                                                            comparative quality and cost       implement cost-saving, safety-enhancing
   improvements                                                             information on state               programs on a state-wide basis.
                                                                            website.
    Total Cost        •   No details.                                   •   Approximately $168             •   Details to come with Blue-Cross/Blue Shield
                                                                            million.                           “Roadmap” study.
How Will We Pay for   •   No details.                                   •   $15 million from “free-rider   •   Employer responsibility assessments.
                      •   Governor Romney has suggested that this           surcharge.”                    •   $.50/pack cigarette tax increase.
        It?               major health care expansion won’t cost        •   $60 million in increased       •   Savings from free-care pool.
                          anything, and that the costs of “Safety Net       federal re-imbursements.       •   Federal Medicaid matching funds.
                          Care” can be funded entirely from money       •   $93 million from State         •   If necessary, other revenue sources.
                          that is currently going into the free care        Reserves.
                          pool.




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Analysis   The are several serious concerns about the           Although there is little conflict   Obviously, GBIO believes that this is the best,
           Governor’s “plan:”                                   between the Travaglini plan and     most realistic plan to expand access to quality,
           1. The “Commonwealth Care” health care               the GBIO/Health Care for All        affordable health insurance to the uninsured and
               product may be so limited in its coverage        plan, the Travaglini plan is much   underinsured. Some of the principals that make
               and so expensive in its co-payments and          more limited in scope:              this the strongest plan can be outlined as follows:
               deductibles it that rational people will chose                                       1. Comprehensiveness: this plan expands
               not to buy it, thus making it a non-solution.    1.   The primary emphasis is on          access to the uninsured, provides support to
           2. Making a stripped-down “Commonwealth                   increasing Medicaid                 the under-insured, and reduces overall
               Care” product available to employers may              reimbursements to hospitals         upward pressure on health insurance
               cause a “race to the bottom,” as employers            and on creating a re-               premiums.
               drop traditional health insurance plans and           insurance program for the      2. Simplicity: Rather than create new,
               purchase for their employees this bare-               individual/small business           complicated programs, we seek to expand
               bones product, thus increasing the epidemic           market.                             access to programs we already know work.
               of under-insured people.                         2.   There is no immediate
           3. Romney has not filed any legislation to                expansion of coverage for      3. Commitment to quality: We do not seek to
               create “Safety Net Care,” so there are no             the working poor.                   replace the problem of un-insurance with the
               details whatsoever. It is concerning that the                                             problem of under-insurance by creating
               Governor would de-emphasize health care          For this reason, we see this plan        bare-bones insurance plans that will cause a
               for the working poor by phasing it in last.      as a supportable first step, but         race to the bottom.
               It is also concerning that this program could    not a complete solution to the      4. Reality: There is no way to expand access
               provide significantly fewer benefits than        serious problem of the uninsured         to quality, affordable health care for free.
               MassHealth. On the other hand, it is a good      and under-insured in                     We propose reasonable mechanisms for
               sign that the Governor has acknowledged          Massachusetts.                           funding these improvements.
               the need for publicly-funded insurance for
               people in this income bracket.
           4. Romney has suggested that the costs of this
               program will be recouped entirely from
               reductions in the free-care pool, so it is
               unclear if any safety net will remain for
               those who slip through the numerous
               remaining cracks.
           5. If cheap insurance products and cost-free
               public health care expansion were possible,
               they would have been created by now.
               There are serious concerns about the
               viability of Romney’s proposal at every
               level.




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