The Health Policy Issue of the State of Massachusetts - Essay Example

Health Reform The Health Policy Issue The comprehensive health care reform of the of Massachusetts was implemented due to concern that some low-income individuals would go from being uninsured to being underinsured (Long 2008). Although the overall objective of the Massachusetts’ comprehensive health care reforms was to make sure that the coverage would be adequate and affordable, this necessitates residents to obtain health insurance that does not provide minimal financial protection (Long 2008). The goals of the health reform are explicitly defined as: to have expanded coverage, to ensure customer satisfaction and preferences, to focus on value between providers and insurers, and to minimize the burden on tax payers (Haislmaier 2006). The major aspect of the Massachusetts legislation is the conception of the Connector – a statewide health insurance. Connector will act as a “private sate-government chartered (Haislmaier 2006)” one-stop shop ort office where individuals and business employers who have employees numbering from fifty (50) and below will be capable to pay for personal and transferable health insurance coverage (Haislmaier 2006). Underinsurance is a major concern for Massachusetts residences since some individuals will prefers to purchase health plans that entails high cost of sharing to be able to bring lower premiums monthly; and restricted benefits (Long 2008). These factors causes higher health care costs per person and can be the reason why most will choose to go without some benefits of a health care plan just to avoid excess health care expenses (Long 2008). Hence when this happens, workers who earn high salaries are covered for any serious injury or illness; while moderate and low income earners will encounter difficulties if the fee for the care which they will need will exceed the coverage of their chosen health insurance plan (Long 2008). Consequently, individuals suffering with some health problems are also prone to financial risk if they are not properly insured because they have a higher incidence of health care costs (Long 2008). The health reform in Massachusetts paved way to having a low rate of universal individuals during its first year of execution. This likewise involved reduction of financial expenses in acquiring health care and enhancement of access to it (Long 2008). Issues surrounding the provisions of the health reform in Massachusetts are concentrated on two aspects which are: that Massachusetts residents must buy a health insurance, and business that have more than ten (10) employees or personnel which do not provide their workers any health insurance should make payments to the state’s compensated care pool for a per worker contribution scale (Haislmaier, 2006). To straighten out some misconceptions, the objective of the law created for the health reform was to redevelop and deregulate the small group and non-group health insurance markets of Massachusetts (Haislmaier 2006). The legislation also transformed financial support or subsidies which are currently paid to hospitals for treatment of those who are not insured due to low income sot they can purchase health insurance (Haislmaier 2006). A state sponsored health insurance trade or clearinghouse, in this case the Connector, makes work well-organized when there is one place to utilize for a sole activity or purpose (Haislmaier 2006). In this condition, Connector (the health insurance) will match sellers and buyers competently by facilitating a multitude of payments and collections from various sources (Haislmaier 2006). Although the Connector is not created to plan the insurance products that are being offered; and neither is it conceptualized to regulate insurers offering health plans. Because the Massachusetts State Division of Insurance will be the one to “regulate, design and price the plans” which will be presented by Connector. All of which are of course based on the provision of the existing insurance laws in Massachusetts (Haislmaier 2006). Since its inception in 2006, the uninsured adults in the working age range has plummeted significantly, reducing the percentage from thirteen percent (13%) to seven percent (7%) (Draper et al 2008). The reform is more or less an individual directive that stresses the duty of an individual to get a health insurance coverage for himself or herself (Draper et al 2008); while most of the residents in Massachusetts acted in accordance with the mandated legislation, around sixty-two thousand (62,000) taxpayers were estimated to have not been able to meet the expenses for even the lowest cost of insurance and were fined two hundred dollars ($200.00) (Draper et al 2008). Most employees who complied with the health reform law of Massachusetts obtained coverage via their respective employers (Draper et al 2008). The expenditure for employers for the added coverage is quite large, as the increase in cost is estimated to be five hundred forty million dollars ($540 M). Moreover, the expenditure outlay is expected to increase since more residents of the state are liable to acquire employer coverage to evade the tax penalty. Individuals earning around thirty-one thousand dollars ($31,000.00) annually are normally fined nine hundred dollars ($900.00) for non compliance (Draper et al 2008). Most alleged that the Massachusetts health care reform plan was quite successful die to the high enrollment rate for the first eighteen months (18 months) in the program. Although some commented that, especially for individuals who qualify for fund support (subsidies), the program is expected to entail one hundred fifty-three million dollars ($153 M), which exceeds the actual budget (Alliance for Health Reform 2008), even if the enrolment is estimated to grow even higher for the coming months. Shortages of primary care providers are also observed since newly insured individuals line up for medical consultations (Alliance for Health Reform 2008). In connection with the foregoing, much of Massachusetts’ high expenditure rate is attributable to the state’s hospital and insurance markets (Robert Wood Johnson foundation 2009). The cost of per capita health care is bigger than the national average overheads, even if the market is only composed of a small number of insurers which includes concentrated but expensive academic medical centers, making market competition/rivalry a reality is easier said than done (Robert Wood Johnson foundation 2009). Currently around ninety-seven percent (97%) of Massachusetts’ residents are now protected with a health insurance plan, showing that the number of uninsured individuals could be reduced significantly and is feasible (Goldstein 2008). According to the article by Goldstein (2008), President Barack Obama’s projected health reform plan is more or less like the health reform issues that ere employed in Massachusetts several years ago. As it has been before up until now, most employers and businesses are not in favor of the rules which oblige them to provide a health insurance for their workers. And if they do not act in accordance with the directive, they are oblige to pay the fine (Goldstein 2008) – and President Obama’s health care scheme is similar. The budget of the President’s office requires congress to have the vital role in the development procedure of the health policy. Leaders of the congress recognize that they should assist in having consensus about how Americans can afford the appropriate health insurance and have access to high quality health care while making sure that the nation can have the funds for the current health care system (Nichols 2009). Stakeholders and Politics Issue A health bill reform was initiated by Democratic Governor Michael Dukakis in 1988 which in the long run became law. The main stipulation of the health bill reform requires businesses (which has more that six workers/employees) to offer health insurance or otherwise pay an annual per-employee tax of one thousand six hundred eighty dollars ($1,680.00) to support coverage expansions (Massachusetts Health Care Reform: Media Information, n.d.). This factor is necessary for the complete law to be operable. The business community was not in favor of such law and did their best to oppose it. In line with financial troubles caused by the recession, Governor Dukakis’s successor Republican Governor William Weld repealed the law which ended any coverage expansion (Massachusetts Health Care Reform: Media Information, n.d.). Taking into consideration the issues of the previous health bill reform, the authorities concerned in drafting the Massachusetts health reform program in 2006 took note of what happens when a bill becomes a law but does not have the full support of all sides (Massachusetts Health Care Reform: Media Information, n.d.). Hence the 2006 health reform program was done differently. By 2005, various stakeholders in the form of business leaders, providers, insurers, activists, the Democratic legislature and the Republican governor had personal perceptions about how the bill should be done. They worked cohesively together, throwing compromises, having the same objectives and were willing to settle for a “less comprehensive reform” (Massachusetts Health Care Reform: Media Information, n.d.). The time was just about right for the federal government was seeking a new way on how to pay for the uninsured rather than loose three hundred eighty-five million dollars ($385M) in federal money (Massachusetts Health Care Reform: Media Information, n.d.). consequently, their hard work paid off, and the health care reform law was passed through the House of Representatives and Senate with a vote of 192 – 2 as compared to the earlier health bill of Governor Dukakis which only had a marginal win of six (6) votes from both legislative houses (Massachusetts Health Care Reform: Media Information, n.d.). The top political leaders who were the main players in the new reform law of 1996 were: former Republican Governor Mitt Romney who voiced out that having a good health insurance policy is a “personal responsibility”. Additionally, it was his office that recommended the creation of the Connector (Massachusetts Health Care Reform: Media Information, n.d.); House Speaker Salvatore DiMasi was likewise a contributor to the health reform bill and he was the one who wanted to make sure that businesses answered for the health care of their respective employees and sought penalty for those who did not comply; former Senate President Robert Travaglini who recommend the expansion of the Insurance Partnership Program which gives subsidies to employers and the low-income earning employees so they could purchase a private insurance. This suggestion was integrated in the concluding bill (Massachusetts Health Care Reform: Media Information, n.d.). Wanting the health care reform bill to pass, every party involved wound up in consensus (Massachusetts Health Care Reform: Media Information, n.d.). Therefore, the Connector Board was put in place to seek modification in areas where needed. But in spite of the broad consensus for the overall U.S. health care plan (Oberlander et al 2009), Democrats and Republicans approach the health care reform with different priorities, philosophies and various solutions. Hence, even with the support of President Obama’s administration for health reform, the majority of the Democrats in the House and the Senate needs a majority of sixty (60) votes to have the legislation for the health reform get pass the Senate (Oberlander et al 2009). Relatively speaking, a comprehensive reform shows a different financial challenge because the price for the expansion was modest (Oberlander et al 2009), and the bill for universal coverage is more expensive. Hence, more debatable funding resources must be tapped or the present pay as you go regulations must be shelved (Oberlander et al 2009). Recommendations The Massachusetts health care program experiment which requires all state residents to buy insurance has lessened the number of uninsured, to a certain extent due to subsidies made to the low income earners (Terry 2009). Although a disadvantage was cited because of the program’s high-ceilinged costs that has forced the government to elevate taxes and fees and slash some services. Before tackling whether ordinary working families are up for having a health care insurance it is essential to know that low income and middle income families have a hard time meeting the basic costs of living (Perry et al 2009). Many do not have any health insurance that could help them offset the costs of health care that generally makes their finances very unstable (Perry et al 2009). Most families are at risk of losing their employment due to the current economic recession and they do not have any leverage on hand to ease them out of a difficult position when rainy days come. This includes having poor health with no health insurance, making them more prone to the risk of not being able to afford a proper health care plan (Perry et al 2009). Because of ailing economic apprehension and having an overall sense of job insecurity that causes temporary and seasonal jobs, most do not know if they will always have work and be able to maintain a health insurance that is quality with good access to care (Perry et al 2009). As for older working adults, their concern is if they will be able to physically keep up with the demands of the job and where chances for promotion is limited (Perry et al 2009). The issue of cost for transportation in order to get to work has been a financial burden (Perry et al 2009) amidst the economic turmoil. This is attributable to increased gas prices making it steadily difficult for the ordinary citizen just to get to their place of work. Others have to travel quite a long distance from areas where housing costs are lower – this makes them look for alternative on how to find jobs that are closer to home. Transportation expenses vary, not to mention car repairs and maintenance to get the vehicle in good condition as it is the only way on how the worker could positively commute from home to work and vice versa. Since public transportation was inadequate, making commute to city jobs lengthy and expensive (Perry et al 2009). In another arena, most families are not able to afford appropriate health care plans because they have to take care of their children; this entails the need of one parent to stay home. However, this parent desires to work because the family needs additional income and the current earnings is not sufficient to cover the household expenses including child care costs (Perry et al 2009). This circumstance forces women with children to work in low paying jobs like child care and restaurants as this affords them the flexibility to earn a little to help defray family expenses and still meet the demands of caring for their child (Perry et al 2009). But despite the fact that most live simply and thriftily; and despite working hard, finances are tight, limited and uncertain (Perry et al 2009). Because after they have paid their loans, rent and utilities, majority of American families have to struggle in order to meet their other basic needs. And this is in congruence to the pressure instilled by the rising prices of food and gas that has quite a negative impact on the family budget (Perry et al 2009). Due to the many expenses an ordinary family has to encounter, some juggle their available funds and make prioritize spending while most depend on their credit car to augment the gap between the times they receive their pay to the next pay date. Although this may solve the pressing dilemma. However, a new financial trouble arises for the low and middle income families, rising credit card debts that will compound the financial pressure they are already in (Perry et al 2009). As this is often the case, most families have to meet their needs on a daily basis (Perry et al 2009), and are unable to save for the rainy days. Few have sufficient savings and even in careful spending and management of the family budget, saving a portion of their earnings and income is impossible (Perry et al 2009). The lack of financial cushion is an unfavorable situation for households who do not have any savings, in particular for older couples who are due to retire soon (Perry et al 2009). This likewise has a negative impact on those who may loose their jobs because of the ailing economy. And losing a job means losing a health insurance too, if they even had one from the beginning (Perry et al 2009). As far as I am concern the daily living expenses of low income and middle income families should be taken into consideration before they are required to provide for their personal health insurance. While it is true that most become a burden of the federal government in terms of medicines and health care when serious injury and illness arises because they do not have any form of health insurance, it could not be ignored that they have to attend with the pressing and immediate expenses of their day to day living. It also could not be denied that a low income will ultimately eliminate the opportunity for a working individual to acquire a good health care insurance plan since this will be crowded out by the immediate expenses that needs to be solved primarily. Although the negative impact would be that they are compromising their access to having a good health care plan; and are not able to make any means to provide for such in times of need. The pressure of having to survive in order to have the basic needs such as home, clothing and food normally take precedence over anything else. Since the health reform plan is connected with having a good well paying job in order to afford one, it only means that lawmakers and the present administration should find means and ways to improve the economy and upgrade the level of basic salary. While this may be a tall order in present circumstances, the need to have a stable economy and create stable jobs should be of paramount importance while addressing the health care needs of the populace. Maybe the lawmakers or policy makers could find a way on how to make the insurance health plans more affordable without compromising the quality of care that is being given. And while the uninsured and the insured are being taken into consideration, authorities must be likewise concern with the situations of the health care providers. In seeking to provide the best possible health reform program, doctors, nurses and hospitals should also be included in the equation, as the circumstances demand that all are treated as fairly as possible. At the moment Massachusetts is coming to grips with the problem by seeking other forms on how to payback hospitals and physicians (Terry 2009). The escalating lack of access to primary health care is in reality a nationwide problem which needs to be dealt with comprehensively (Terry 2009). And further study is actually needed before implementing the health reform program nationwide. It could be that not all the aspects are studied pervasively and meticulously on how it will affect all concerned parties especially those who cannot really afford to purchase even the lowest cost of health insurance policy. It is not adequate to mandate that everyone must have insurance although everybody really needs one in times of health crisis. But to be able to afford the high cost of health care provision, it is imperative that the administration must be able to provide work for the people which are long term, stable and with a monthly wage that could spare an amount to pay for the premium of the insurance. Requiring everyone to maintain a health insurance alongside with daily living expenses, which are both high and expensive, will force individuals to give up paying their health insurance premiums so they can add the money to buy staples that would allow them to live and see another day. The present economic crisis makes it hard for everyone to live up to the standards which others may thing would benefit them in the long run. But being unable to have the means to live up to that required standard and still have to pay for the usual daily expenses will not only cripple the financial backbone of any low income and moderate income family, but will eventually make them more hard up financially that they might not be able to even afford the usual basic needs like food. Reference List Alliance for Health Reform. (2008). Massachusetts Health Reform: Bragging Rights and Growing Pains. Retrieved March 22, 2009 from http://www.allhealth.org/briefing_detail.asp?bi=128 Draper, Debra, Felland, Laurie, Liebhaber, Allison, Lauer, Johanna. (2008). Massachusetts health Reform: High costs and Expanding Expectations May Weaken Employer Support. Issue Brief No. 124. Retrieved on March 21, 2009 from http://www.hschange.com/CONTENT/1021/ Goldstein, Jacob. (2008). Health Reform in Massachusetts Holds Lessons for Washington: The Wall Street Journal Blogs. 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(2009). In Obama Reform Push, Medicare Leads the Way. Health and Affairs: the Policy Journal of the Health Sphere. Retrieved March 19, 2009 from http://healthaffairs.org/blog2009/02/27/in-obama-reform-push-medicare-leadstheway?s... Oberlander, Jonathan B., Lyons Barbara. (2009) Beyond Incrementation? SCHIP and the Politics of Health Reform. Health Affairs, the Policy Journal of Health Sphere. Retrieved March 21, 2009 from http://content.healthaffairs.org/cgi/content/full/hlthaff.28.3.w399/DC1 Robert Wood Johnson Foundation. (2009). Massachusetts Health Reform: Solving the Long-Run Cost Problem. Retrieved March 22, 2009 from http://www.rwjf.org/healthreform/product.jsp?id=37511 Terry, Ken. (2009). Massachusetts Needs to Deal with Primary Health Care Crisis: bnet. Retrieved March 21, 2009 from http://industry.bnet.com/healthcare/1000452/massachusetts-needs-to-deal-with-primary-care-crisis/ Read More