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Health Plan Pressures Massachuetts FirmsFrom: DMECNM@aol.com (dean@thehuffpeople.net)Sun Oct 30 12:19:43 2005
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>From today's Boston Globe - - - - Health plan pressures Mass. firms House bill: Insure workers or pay state By Scott S. Greenberger, Boston Globe Staff | October 30, 2005 Massachusetts businesses with more than 10 employees would face a financial assessment by the state if they did not provide healthcare coverage to their workers, under a new House healthcare plan that aims to cover virtually all the state's uninsured within three years. The plan, to be unveiled formally in a House committee tomorrow, is designed to encourage businesses to provide health insurance coverage and reward businesses that already do. Legislative sources also said that House leaders are backing off their initial plans to impose new taxes on alcohol or cigarettes, in the latest version of the bill circulated among lawmakers yesterday. The House plan, as previously disclosed by lawmakers, also would require individuals to buy health insurance if they can afford it and would significantly expand Medicaid coverage for the poor, according to House sources. The plan envisions offering individuals a stripped-down private health package for as little as $140 a month. The House bill is the next step in a high-stakes healthcare debate involving Governor Mitt Romney and Democratic legislators. House Speaker Salvatore DiMasi has said he wants to pass a bill before the formal end of this year's session on Nov. 16, a timetable that some strategists see as unlikely. "This is the only bill where the numbers add up to ensure that more people will have access to affordable, quality healthcare," DiMasi said yesterday. The plan aims to cover 95 percent of the state's roughly 500,000 uninsured within three years, according to the House sources. The decision to drop taxes from the House version of the bill makes it unlikely that the healthcare legislation that emerges from Beacon Hill would include new taxes, since neither Romney nor Senate President Robert E. Travaglini has new taxes in their own proposal. Instead, the House would use up to $250 million from the state's 1998 tobacco settlement to help pay for new costs to the government, including the Medicaid expansion. But the proposed insurance requirement for businesses, while praised by healthcare advocates and hospitals, is sure to face strong opposition from the state's powerful business groups, which are against any mandate on employers. Travaglini has a much narrower insurance requirement for employers in his proposal, but Romney appears unlikely to support a new requirement on employers. "We believe it's unnecessary to have an employer mandate as a way to get everyone insured," said Timothy R. Murphy, state health and human services secretary, who is the primary architect of Romney's plan. The governor has not ruled out such a requirement, but Murphy called the House proposal "a big bridge for us to cross." Under current law, businesses that provide coverage to their workers pay a surcharge to the state's free care pool that raises money to help the state cover the cost of care for the uninsured, but employers that don't cover their workers don't have to contribute. The House plan would create an incentive for employers to offer coverage by allowing them to deduct their healthcare costs from whatever they would owe the state. As a result, according to House sources, employers who cover their workers would pay the state less than they do now, and many would not have to make any payment at all. Businesses with 10 or fewer workers would be exempt from the requirement, meaning that most of the state's firms would escape the potential assessment. At least 65 percent of the state's 149,000 firms have 10 employees or fewer, according to US Census data from 2001. John McDonough, executive director of Health Care for All, one of the leaders of a broad coalition of advocacy groups and religious congregations pushing to put a healthcare plan on the November 2006 ballot, described the House proposal as "tremendously encouraging." The group's ballot initiative includes a similar requirement for employers. The goal of the proposed assessment is to make it more financially attractive for employers to provide insurance. Employers typically pay 12 to 15 percent of their payroll for employees' health insurance. The House has not settled on how much the assessment would be, but it would be less than that, sources said. McDonough said the House plan has been reviewed by Jonathan Gruber, a healthcare specialist and economics professor at Massachusetts Institute of Technology who has determined that it includes enough money to cover 95 percent of the uninsured. The state estimates that there are between 460,000 and 532,000 uninsured people in Massachusetts. But the US Census Bureau reported two months ago that the number of uninsured residents in the Bay State increased to 748,000 last year, up by 66,000 from 2003. Daniel P. Moen, president and chief executive of Heywood Hospital in Gardner and the chairman-elect of the Massachusetts Hospital Association, also praised the House plan. Hospitals and other healthcare providers have long contended that the state does not fully reimburse them for free care they provide, and the House plan sets aside $80 million to boost those payments. "It sounds like it has many of the features that we've stressed in our communications with the leadership -- things like shared responsibility, for example, with both an employer and an individual mandate," Moen said. But business leaders were dubious that the House plan could spare employers who cover workers from any additional payments. They suggested that any sort of requirement would put a damper on job creation. "Any kind of payroll tax would harm job creation. When you increase the price of something, you get less of it, and this would be an increase in the cost of providing jobs," said Jim Klocke, executive vice president of the Greater Boston Chamber of Commerce. Bill Vernon, state director of the National Federation of Independent Business, said "no employer mandate would be palatable." "I don't think we have to do it. I think we ought to try to keep the state competitive, to try to do it without an employer mandate," Vernon said. "And three, four, five years down the line, if that doesn't work we'll go back." As the Globe has reported previously, the House also wants to require people who can afford health insurance to buy it, provide subsidies to lower-income people and small businesses to help them pay premiums, and raise the income limits for MassHealth, the state's Medicaid program, so an additional 130,000 people can enroll. In addition to covering more children and parents, House sources disclosed last week that the House proposal would for the first time extend MassHealth coverage to childless adults, covering those with incomes up to the federal poverty level, which is $9,570. Romney's endorsement of a requirement that individuals buy coverage significantly boosts the prospects of that idea on Beacon Hill. Romney has a requirement in his own plan, and Travaglini has said he is open to the idea, though he has not committed to it. If Massachusetts forces individuals to purchase health insurance, it would be a national pioneer: No other state has such a requirement. A study released recently by the Urban Institute contends that it would be impossible to cover the Bay State's uninsured without an individual mandate, either by itself or in combination with a requirement that employers cover their workers. The Romney administration estimates that about 200,000 of the state's roughly 500,000 uninsured make at least three times the federal poverty level, or $28,710 for a single person, and could afford to buy private insurance with some state help. Romney has said that many of them are young, male, single, and simply gamble that they won't get sick. If they do, they go to hospitals and get care they never pay for, because the hospital and state pick up the tab. Romney wants to combine the mandate with rule changes that would allow insurance companies to offer limited, low-cost policies, and state subsidies to help people buy them. Earlier this month, Blue Cross Blue Shield produced a policy for the governor that would cost only $200 per month, saving money by steering people away from emergency room visits and high-cost procedures and eliminating coverage for chiropractic care and in vitro fertilization. Under his plan, residents who choose not to obtain health insurance would face tax penalties and even the garnishing of their wages. The House plan also would provide subsidies, and it envisions low-cost policies that many more people will be able to afford. But instead of scaling back some benefits, as Romney would, House leaders believe they can craft a roughly $320-per-month plan by allowing insurers to charge higher deductibles and copayments
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