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$380 rate for health coverage called high
Lower healthcare bids are requested
By Alice Dembner January 23, 2007...Mandating health insurance coverage that would cost the average individual $380 a month is untenable, a state board decided yesterday. The board, which is overseeing the state's universal health insurance law, postponed a vote yesterday to set minimal requirements for coverage and instead requested lower-cost bids from insurers. "Clearly, $380 is not what we consider affordable" for minimal coverage, said Jon Kingsdale, executive director of the board, the Commonwealth Health Insurance Connector. The board's decision to press insurers for less costly insurance plans followed outcry from advocates, hospitals, and lawmakers. Governor Deval Patrick and legislative leaders intervened over the weekend, advising board members not to press ahead with a standard that some suggested could undermine the goal of universal health coverage. At a State House press conference yesterday, Patrick said: "I'm worried, based on the affordability sessions that I've been to, that $400 for someone who is at 300 percent of the poverty level may not be affordable." Under the law, all adults must obtain coverage by July 1 or pay a penalty, unless they secure a waiver by proving they can't afford insurance. The board must decide what level of coverage will satisfy that mandate. Individuals earning less than 300 percent of the poverty level, or $29,400, are eligible for a separate, state-subsidized insurance package. But for an estimated 160,000 to 200,000 people, the minimum plan probably would be the least expensive they could buy. A subcommittee had recommended Friday that the board set standards that appeared to come with a $380 monthly price tag, even though they were distressed about that price. But yesterday, the board chairwoman, Leslie Kirwan, said that some insurers have offered lower-cost coverage and that the board would press others to do the same. "Affordability and choice are critical issues for us," said Kirwan, administration and finance secretary in Patrick's administration. "Massachusetts citizens deserve both." Neither Kirwan nor other board members would set a target premium yesterday, but the board had expected to get plans with premiums of about $260, or $3,120 per year. After the meeting, House Speaker Salvatore F. DiMasi said in a telephone interview: "We feel that these products should be and can be priced at a reasonable level, under $300." But state Senator Richard T. Moore, cochairman of the Legislature's Committee on Health Care Financing, suggested that the price should be even lower. "If it's not affordable, we're going to be forced to grant too many waivers, and that doesn't help our problem of trying to shift people away from the emergency rooms," Moore said in a phone interview. "They should be aiming at $250." The board decided to ask insurers to submit new bids for coverage that would meet certain requirements: It should provide "reasonably comprehensive coverage," including primary care, emergency services, hospitalization benefits, and mental health services. It should also limit annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family, and include prescription drug coverage. Deductibles should run no higher than $2,000 per individual and $4,000 per family, according to the board request. And before the deductible kicks in, the plan should cover generic drugs and three medical visits for an individual to encourage preventive care. Insurers would not be allowed to set limits on coverage per sickness, year, or lifetime, nor could they set a dollar maximum of coverage for any medical service. But Kirwan said the board can reconsider those requirements if the new bids are too costly. The new bids are due in a couple of weeks, and the board expects to vote on the plans at its March 8 meeting. That would allow the board to stick to the timetable laid out in the law. But yesterday, Eric Linzer, vice president of the Massachusetts Association of Health Plans, said that the board was being "overly prescriptive" and that it would be "a huge challenge" for insurers to meet all requirements and keep costs down. |