Romney gets look at $200 coverage

Blue Cross Blue Shield of Massachusetts gave Governor Mitt Romney an outline of a possible health plan with the $200-a-month premium the governor wants to launch as part of his effort to provide affordable coverage for uninsured individuals.

The basic HMO plan from Blue Cross, the state's largest health insurer, would increase patients' out-of-pocket costs such as deductibles and co-pays; add costs to steer people away from costly emergency room visits and high-tech procedures such as MRIs; and eliminate some benefits currently required by the state to be covered in all health plans, such as chiropractic care and in vitro fertilization for infertile couples. The plan would probably include some coverage for preventive care, physician and hospital visits, and prescription drugs.

The Romney administration, facing a legislative deadline, has asked health insurers to design a health plan with a $200 monthly premium. Senate President Robert E. Travaglini and others have their own competing health coverage plans.

''What this does, from our perspective, is validate everything we've spoken about on healthcare reform," said Tim Murphy, secretary of the Executive Office of Health and Human Services. ''We didn't make this up on our own. It disabuses the whole notion that these are stripped down, bare-bones products."

There are currently about 460,000 people in Massachusetts -- or 7 percent of the population -- who lack health insurance, according to the governor. Many of those people wind up seeking noncritical care in hospital emergency rooms that must treat the uninsured, pushing up the cost of healthcare for everyone else.

Under the Romney plan, insurers will design low-cost health plans and sell them to employers. There wouldn't be a single state-mandated program.

Romney has made providing coverage for the uninsured in Massachusetts a centerpiece of his agenda, and has unveiled parts of his plan over the past year. In particular, he has proposed a low-cost HMO that would provide ''comprehensive" coverage for $200 a month, or about half the current market-price premium.

At that price, buying coverage would be possible for many who make too much money to qualify for Medicaid, the federal-state program for the poor, and not enough to buy insurance at current prices. The state would subsidize the $200 program for people who don't qualify for Medicaid but whose income is below a certain level. Romney's program would be mandatory. To encourage enrollment, the plan would also impose tax penalties on consumers who could buy the low-cost insurance but choose not to.

But critics contend that Romney's effort is little more than wishful thinking until a complete plan is put on the table.

''It's time for the governor to put up or shut up," said John E. McDonough, executive director of Health Care for All, a Boston advocacy group. ''Until the insurers come forward with an explicit plan that says here's what we're going to offer, here's what it's going to cover, here are the limitations, and here's the price, it's unacceptable for the Legislature to impose the coercive powers of the state for people to buy something they don't understand."

Earlier this month, House Speaker Salvatore DiMasi promised the Legislature would pass a bill to overhaul healthcare before the session ends Nov. 16, or he would call members back from recess.

Susan Leahy, a Blue Cross spokeswoman, said the proposal sent to the administration on Oct. 13 isn't an actual product. She said it is a set of options to ''promote discussion on expanding healthcare access." The outline is based on a Blue Cross HMO for smaller employers, which has an average $400 monthly premium. From there, Blue Cross looked for coverage cuts and other changes that would get to Romney's target premium of $200 a month.

The biggest cuts come from increasing deductibles and co-pays, what insurers call ''cost sharing." Those could reduce premiums between 15 percent and 45 percent, according to the Blue Cross material sent to the administration. Steering patients away from emergency rooms and high-cost imaging technology provides the next largest savings, perhaps as much as 15 percent of the total.

Blue Cross said further costs cuts can be gleaned from trimming some benefits such as chiropractic care and creating incentives to get people to stop smoking. The plan also suggested limiting the number of prescription drugs available and requiring that consumers buy generic drugs.

Michael Doonan, an assistant professor at Brandeis University and executive director of the nonpartisan Massachusetts Health Policy Forum, which researches healthcare options in the Bay State, said he worried that ''cost sharing" would hurt patient care. Research shows that when faced with higher deductibles and co-pays, people may forgo necessary treatment. In addition, he said, high cost sharing can leave people vulnerable to accumulating high levels of medical debt.

Murphy, the secretary of health and human services, said low-income people who might be hard hit by the higher out-of-pocket costs would be eligible for subsidies under the governor's plan, which would lower their premiums below the $200 a month target and eliminate deductibles.

''We know that if you're making $19,000 a year and there's a $500 deductible, you'll end up with people not using the healthcare system," he said.

The governor's plan aims to provide coverage for the uninsured without spending any additional money. It would take money used to compensate hospitals for treating the uninsured and use it instead to pay for the insurance. But some legislators believe it will be impossible to expand coverage without putting more money into the system.

State Senator Mark C. Montigny, Democrat of New Bedford and former chairman of the joint healthcare financing committee, said neither Romney's proposal nor another from Senate President Robert Travaglini can really resolve the problem of providing coverage for the uninsured because of a lack of financing.

''Nothing on the table today gets us what we're all saying we want, which is a major health care expansion," he said. ''The only thing worse than a high-priced policy that you can't afford is a low-cost policy that you can't use. You end up being de facto uninsured, but now you're paying for it."

Jeffrey Krasner can be reached at krasner@globe.com.