Managed Care - May 2008 - (Page 48) Programs offered ere’s how the Commonwealth Health Insurance Connector Authority describes the two programs it offers. Commonwealth Care is a subsidized program for adults who are not offered employer-sponsored insurance, do not qualify for Medicare, Medicaid, or certain other special insurance programs, and are at no more than 300 percent of the federal poverty level (FPL). In 2008, 300 percent of FPL is $31,212 for an individual and $63,612 for a family of four. There are no monthly premiums for adults earning 150 percent or less of the FPL. That’s $15,612 for an individual; $31,812 for a family of four. Plans are currently available for $35 a month for an individual earning between $15,613 and $20,808; $70 for an individual earning between $20,809 and $26,016; and $105 if earning between $26,017 and $31,212. There are no monthly premiums for the children of adults covered by Commonwealth Care. These children are covered by MassHealth (Medicaid). Commonwealth Choice is an unsubsidized offering of six private health plans, selected by competitive bidding and available through the Health Connector to individuals, families, and certain employers. The six private plans have received the Connector’s “Seal of Approval” to offer a range of benefit options, grouped by level of benefits and cost-sharing at the bronze, silver, and gold levels. There is also a special, lower priced Young Adults Plan offering from the same six carriers, exclusively for people between 18 and 26. These plans are offered directly through the Health Connector by six Massachusetts-based, not-for-profit health insurance carriers: • Blue Cross Blue Shield of Massachusetts • Fallon Community Health Plan • Harvard Pilgrim Health Care • Health New England, Neighborhood Health Plan • Tufts Health Plan Together, these plans constitute about 90 percent of the commercial licensed health insurance market. Each of the plans offered through the Health Connector by the six carriers may also be purchased directly from the individual carriers. Starting in the summer of 2008, employers with 50 or fewer workers will also be able to purchase directly through the Health Connector. H took the money, all right, but there are still uninsured to whom hospitals must still deliver uncompensated care. State officials respond that the goal had always been “near universal” care. It’s a little less clear how health insurance plans are being affected, says Tanner. “They’ve tried to pressure the health care plans to cut back reimbursement rates.” Kingsdale reports that insurers have been good partners. “They scurried around like crazy, throwing programs together for us and working with us.” Not without benefit to insurers, either. “We grew private commercial insurance here by 110,000 last year,” says Kingsdale. “That’s a significant increase in a small state with a static population.” Kingsdale also dismisses Tanner’s assertion that RomneyCare didn’t address the problem of the uninsured. He says that 340,000 is a lot of people. “Does that cost more money? Yeah. Is cost for the program per person out of control? No. Is the political commitment to fund it still there? Yes.” (Tanner is sticking by his assertions. The estimates for how many uninsured there were in Massachusetts before RomneyCare range from 500,000 to 600,000.) It’s important to think of the law as a work in progress, says Buyse, of the Massachusetts Association of Health Plans. “I would expect that as we gain more experience about what’s working well and what isn’t working well, we’re going to make adjustments.” For instance, the plans are pushing a product specifically designed for young invincibles. “It has lower costs and limited benefits and should be very attractive. Hopefully, it will be more attractive than paying the penalty, for which you get nothing.” Everyone agrees that primary care doctors are being swamped. However, just what causes that and how it might be combated are topics of debate. The problem has little, if anything, to do with RomneyCare, says Magee. “I think the last thing I would blame is our health insurance program,” says Magee. “We’ve got residency programs configured to turn out a lot of specialists and not too many primary care physicians. What we’re talking about with 340,000 patients is basically 5 percent of the population. It’s one more straw on the back of an already strained system, but the system is elastic enough to absorb 5 percent.” Kingsdale views the PCP shortage as an oppor- 48 MANAGED CARE / MAY 2008
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