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    Sunday, July 01, 2007

    Mandated Mandates: Today is the day that Massachusetts residents have to have health insurance or else be penalized. Well, not really. They have until December 31 it turns out, to really have health insurance. The penalty:

    Massachusetts is deliberately taking things slowly. In 2008, the penalty for those not insured will be a loss of state tax exemption, worth about $219; later the penalty will be up to half of a monthly insurance premium for each month a person is uninsured. Also, while any insurance is acceptable at first, by January 2009, everyone must have drug coverage.

    There is concern that there will be about 60,000 people who are not poor enough to qualify for state aid to buy insurance and yet who will also not be able to afford the premiums themselves. So why are they mandating drug coverage? Wouldn't it make sense to drop the drug coverage mandate so that there will be more affordable policy options for those 60,000?

    posted by Sydney on 7/01/2007 01:36:00 PM 5 comments


    I'm not following your causal assessment. How exactly will dropping the mandate provide coverage for these 60,000 persons? Isn't it much more likely that such a class -- who earn too much to qualify for Medicaid, but who cannot afford private insurance -- would be shut out from coverage anyway>

    By Anonymous Anonymous, at 2:57 PM  

    When an insurance company has to offer drug coverage, it means that the policies are more expensive. If they had the option to offer a policy that didn't cover drugs, then they could offer lower-cost plans which could make them affordable to at least some, if not all, of those people who can't afford the current coverage may be able to afford the cheaper insurance without drug coverage.

    By Blogger sydney, at 12:31 PM  

    Furthermore, it's a nice feeling to think that one is in a "low risk" category for health complications. So it'd be nice to "reward" those conscientous people everywhere who don't smoke, exercise, drink in moderation and take their baby aspirin, with lower premiums. Too bad for the folks with genetic risks, I guess.

    But, we physicians know what a "risk factor" is, don't we? It's not a guarantee, and the lack of risk factors doesn't give us some kind of deflector shield against illness. I do think we have led the public to believe it does, though.

    As I said, let's distinguish policies on convenience factors and deductibles, but not on meaningful coverage.

    By Anonymous danie, at 2:44 PM  

    There are two problems with dropping drug coverage- one, some studies show coverage can reduce overall costs through decreased hospitalizations. I believe that we will definitely see this with Medicare.

    Sydney, you properly pointed out that those who join a plan with no drug coverage will pay less- but you miss the other half of the equation. Those who need medications will suddenly see their policies skyrocket. This is the whole point of risk pooling, and it is what mandatory health insurance is trying to get accomplish. Why do big companies get better health insurance rates? The ability to spread risk over many lives. Massachusetts is just trying to do the same thing. For this to work, everybody has to play.

    There are many other ways to decrease the costs of a policy- high deductibles, restricted formularies, restricted panel of providers, no travel coverage, etc. But you can't discriminate based on clinical risk or the whole project will fail.

    By Anonymous danie, at 2:47 PM  

    My posts were reversed, sorry!

    By Anonymous Anonymous, at 2:48 PM  

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