THE GOOD news is that enrollment in the state's new subsidized health insurance program has greatly exceeded projections. The bad news is that this has raised the first-year cost of Commonwealth Care from an expected $472 million to $630 million. To fill the gap, the Patrick administration has devised a plan that spreads the pain relatively equally among health reform's major stakeholders, from providers to employers to insurers and the state itself.
The most important stakeholders - the individuals and families who have signed up for the state's pioneering effort at universal coverage - have already done their bit. In April, their premiums rose 10 percent and their co-payments also increased. The Legislature should approve the governor's proposal or come up with a better one before it adjourns at the end of this month.
Under the governor's plan, an employer would have to pay an annual assessment of $295 per uninsured worker unless it offers a health plan enrolling at least 25 percent of its workers and pays at least 33 percent of its employees' health premiums. Until now, employers have been able to avoid the assessment if they met either criterion. The state calculates this change would hike employer assessments by $33 million. Insurers would face a one-time assessment of $33 million, and providers would have to kick in $28 million. The state would draw up to $35 million from a surplus in a fund for health insurance for the unemployed.
If lawmakers do not act, the alternatives are sobering. The state could reduce spending for other programs or further increase charges to subscribers, putting coverage beyond the reach of some. Or it could cut off enrollment in Commonwealth Care. But this would not only leave consumers without access to affordable coverage, it would also probably make it impossible for the state to enforce the mandate on individuals to get insurance. Thanks to Commonwealth Care, the mandate, and other elements of the state's reform plan, a recent survey found that the percentage of uninsured in the state had fallen from 13 percent in the fall of 2006 to 7 percent last fall.
A poll released today by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation found strong public support for health reform and a 66 percent majority against capping enrollment in Commonwealth Care to limit its costs. To keep that backing, legislators should quickly find a way to pay for Commonwealth Care's success without gutting other state programs or putting an undue burden on the newly insured. The Patrick plan to achieve this is a good start.
