Cape Lawmaker wants to lift health care fine

posted Feb 22, 2011, 2:01 PM by Elysse Magnotto-Cleary   [ updated Feb 22, 2011, 2:08 PM ]

As published in the Cape Cod Times

February 19, 2011
While the governor and the Legislature attempt to control rising health care costs, one Cape lawmaker has introduced legislation he believes will take the pressure off citizens who are choosing between mandatory insurance or paying a state penalty.

The Help Expense Lowering Plan (HELP), introduced by Rep. Randy Hunt, R-Sandwich, would suspend the state's minimum coverage requirements on health insurance until Jan. 1, 2014, when national health reforms go into effect.

Plan details

There would be no fine ($1,212 in 2011) for not complying with Minimum Creditable Coverage requirements. The requirement for insurance of some kind would remain in place.

Certain categories of care would not need to be covered, such as maternity care and prescription drugs.

State residents would still be required to carry some form of health insurance but would no longer have to pay for certain categories, such as prescription drugs or maternity and newborn care coverage.

Hunt said the change could save ratepayers thousands of dollars.

"Not everybody is going to be able to afford the blue ribbon policy that legislators gift to themselves," Hunt said. "It's just a fact that not everybody can buy a Cadillac."

Massachusetts residents are required by law to have health insurance meeting a Minimum Creditable Coverage requirement. Those who do not comply will pay a $1,212 fine in 2011.

It's unnecessary for Massachusetts residents to choose between a fine and some of the highest health insurance premiums in the country when cheaper, less expansive coverage could work for some, Hunt said.

Hunt used the example of a married couple in their 30s who would only pay for catastrophic coverage while paying for broken bones and doctor visits out of their own pockets. Without the threat of fines, the couple could save more than $5,000 in premiums, Hunt said in a press release.

But Dr. Brian O'Malley of the Cape Care Coalition, a not-for-profit community health insurance program for Barnstable County, said what Hunt calls "blue ribbon plans" are actually basic health care services. He expressed surprise at some items Hunt lists as optional in his plan.

"Knocking off maternity services, emergency services — what piece of this does he see as silly?" O'Malley said.

The proposal is not meant as a permanent solution to Massachusetts' health care costs, Hunt said. It is meant to remove some of the financial burden from residents while larger questions on controlling health care costs are solved.

"All I'm saying with the HELP Act is: give us some relief now, because we need it dearly," he said.

A 2009 study by the Commonwealth Fund, an independent private health care foundation, found Massachusetts had the highest family health insurance premiums in the country at $14,723. That's $1,700 dollars more than the national average. The figure was based on average private group employer-based insurance for employer-sponsored plans.

Professor Alan Sager of Boston University's School of Public Health believes that what people need is more health care, not the option for less.

Hunt's bill would send the state on a road to fewer services and more medical and financial risk, especially for people of average income or below, Sager said. Unlike the free market ideals on which Hunt's proposal is based, health care is an esoteric and highly specialized endeavor, Sager said.

"This is not like buying a toaster or even like buying a new car. Good information on price and quality is not available," Sager said.

What Hunt touts as savings on routine health care costs could actually overwhelm uninsured individuals if they should get injured, Sager said. The lower premiums in Hunt's plan would be traded for higher prices for hospital care, doctor care and prescription drugs, Sager said, noting that insurance companies are able to get lower rates for treatment due to their leverage.

Hospital coverage can cost up to three times as much for uninsured individuals paying out of pocket, Sager said.

But Michael Cannon, director of health policy studies at the Cato Institute, a conservative think tank, said Hunt's proposal does not go far enough.

"I think it will provide a small amount of relief to a small number of people but is completely inadequate to the task of controlling rising health care costs in Massachusetts," he said.

The bill is supported mainly by Republicans, including Senate Minority Leader Bruce Tarr, R-Gloucester.

Rep. Cleon Turner, D-Dennis, is the lone Democrat among the bill's 10 co-signers.

The 2006 state health care reforms were passed quickly with the intent to amend them later as problems arose, Turner said in a statement to the Times. He hopes Hunt's bill will provoke discussion about current premium rates and policies to fix what he said were mistakes in the original law.

"The result has been, in my opinion, that insurers have benefitted greatly and individuals and small businesses are struggling to pay premiums for minimal coverage," Turner said.