Health-care insurance rules altered

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State House News Service

BOSTON, MA — A year after legislation intended to make health-insurance coverage universal was signed into law, the state entity implementing the landmark measure unanimously voted yesterday to exempt about 60,000 people, or 20 percent of the state’s adult uninsured population, from the mandate to purchase insurance.

“The impact of what we’ve done is to say that 99 percent of the people in Massachusetts will be covered. That’s more than any other state, so we think this is a huge, huge step forward and it’s as close as you can get to universal coverage,” said Leslie Kirwan, chair of the Connector Authority board, the agency empowered to create the new health-insurance system.

Kirwan said the board had to approach the law’s mandate to require nearly all residents to purchase health insurance in a “humane” way by not harming residents financially.

Connector Authority board members yesterday said they reached their best compromise in determining who should not be penalized for being uninsured.

Without much discussion, the board unanimously approved a schedule of affordability that determines who would be automatically waived from the mandate based on individuals’ income level, age and area of residency. The board also agreed to expand premium-free insurance plans to another 29,000 low-income uninsured people and to lower premium contributions for 23,000 residents.

Under the vote, uninsured residents who earn less than $15,300 a year will not have to pay for state-sponsored health-care insurance plans. Currently, individuals who earn between $10,200 and $15,300 and are enrolled in the state’s Commonwealth Care products, have to pay $18 in monthly premium while residents who earn less than $10,200 do not have to pay premiums.

The board also lowered premium contributions to $35 from $40 a month for 23,000 individuals who earn between $15,300 and $20,400.

The newly adopted regulations are estimated to cost an additional $13 million in the next fiscal year and result in insurance of 99 percent of the state’s adult population. As of August of 2006, 94 percent of the state’s population had insurance, according to the Division of Health Care Finance and Policy.

During a radio appearance, Governor Patrick said he supports a “robust and compassionate” waiver for people “who practically can’t afford” insurance. He also said he supports exempting some 60,000 uninsured residents because it would “postpone the time to transition folks into the system” and stave off anxiety about the law.

“This is about trial and error,” Patrick said, stressing the state’s pioneering attempt to implement the new health-care reform law.

Patrick talked about the importance of outreach efforts to educate the public about the mandate and the new health-insurance products. He said work with the advocacy groups will be crucial to reach out to the general public.

Kirwan said she hopes people who would be exempted from the mandate still try to enroll in health insurance.

The vote was followed by applause from the nine-member board and the audience. Members acknowledged they wouldn’t have thought they would have reached a consensus yesterday given their differences at last week’s board meeting.

Board member Rick Lord, the head of a major business trade association, said a week ago, “we were all pretty far apart.” He said everyone on the board had to “move” to agree to be together in one place.

“In the end people learned with each other, talked to each other and fought hard,” said board member Celia Wcislo. “We come from very different ideological places. We all have things we want to tweak. But we’re going to learn and probably make huge mistakes that we’ll learn about.”

She said her vote will get the one-year-old law closer to insuring a vast majority of the uninsured.

Board member Charles Joffe-Halpern said yesterday’s vote lifts an entire socio-economic group to full health-care participation. “This really is a historical moment and Massachusetts certainly is a role model,” he said.

The Connector plans to hold public hearings on the new regulations next month and take a final vote in June.

The Rev. Hurmon Hamilton of Roxbury Presbyterian Church, president of Greater Boston Interfaith Organization, praised yesterday’s board decision.

Hamilton has rallied in the past to push the Connector to exempt all individuals earning less than $51,000 from financial penalties. “This is an uncommon day,” Hamilton. “It’s uncommon because usually decisions of this magnitude are often made by one or two extremes.”

The California-based health-care advocacy group Foundation for Taxpayer and Consumer Rights condemned the state’s approval of high-deductible health plans, claiming they will prevent people from seeking proper health care. “Massachusetts has moved away from the promise of ‘universal’ health coverage at every step as it implements its insurance mandate, and now turns a blind eye to costs that will stop even the ‘insured’ from getting needed care.”

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