As Congress considers the various Obamacare proposals, Massachusetts health care program that began in 2006 is heralded as the magic potion that merely needs to be applied to the rest of our country to cure all its healthcare ills. Let’s take a closer look at the Massachusetts plan, some its features, and a hard look at some of its realities. See the full article for details:

Did the Massachusetts Plan Eliminate or Greatly Reduce the Uninsured?

The official count of the state’s uninsured is 4.1% or 263 thousand out of a population of 6.4 million, according to a recent census. Of course, when it is illegal to be uninsured (unless you have an income under 150% of the Federal Poverty Level or meet other narrow qualifying criteria), you are less likely to admit this fact to a census taker, or anyone else for that matter, so this is a strong reason to believe that the uninsured population of Massachusetts is significantly higher.

Did the 2006 mandate make a big difference in the percentage of the state’s population that is covered by medical insurance? Citing Professor Bernstein of Washington University, CNN reports that the uninsured rate in Massachusetts was low before the state mandated health insurance, largely because wages are higher than much of the rest of the country and there were a higher percentage of employers, such as universities, that already provided health insurance to their employees.

Another problem with the Massachusetts plan is that pushing people into selecting a high-deductible plan may create the illusion of coverage but if the patient can’t afford the deductible and it becomes a barrier to treatment, they don’t really have coverage.

Massachusetts’ Health Connector – Real Plans and Real Examples

Today I took a long, hard look at Massachusetts’ mahealthconnector.org to look at costs for an individual with an income of just over $31,000, age 31 and living in Worcester, remembering that these are STATE-SUBSIDIZED plans:

• The Harvard Pilgrim Best Buy HMO 1000 is $315.19/mo with a $1000 annual deductible. It provides Doctor visit coverage at $20/visit, a $15/30/50 three-tier Rx coverage, ER visits at $100 after the deductible is covered, and hospital stays at $0 after the deductible is covered. This is probably one of the most truly affordable policies, providing immediate access to medical care and pharmacy services without satisfying a deductible, and access to hospital care after satisfying the plan’s deductible. There are a few comparable plans, such as the Fallon plan, that have premiums, copays, and deductibles, that put reasonable limits on maximum annual costs for a state-subsidized plan designed for people of modest means.

• Other plans are offered with higher and lower premiums, each with its own mix of deductibles, copays, and other nuances, but a careful look shows that many may prove to be a barrier to access for those of moderate means. They either have a high deductible to satisfy or have a coinsurance that is high enough without an affordable stop-loss that will make you question whether this is actually insurance — protection purchased at an affordable price to cover unexpected costs that you cannot afford, especially when you remember that these are state-subsidized plans.

An Unsustainable Subsidy

According to the Boston Globe, the state subsidy for providing “affordable” policies to people with income under the “affordability” cap (about $39,000/yr for individuals) will be about $1,300,000,000 for 2009. Yes, that’s 1.3 billion dollars just for the subsidy, and this is about double the 2008 subsidy. At this rate, Massachusetts is going to need either cut its subsidy, adjust the income levels eligible for the subsidy, or seek new revenue sources to finance a subsidy that is growing faster than the state may be able to afford.

If this is a model of what the country is supposed to emulate – a system that appears to be unsustainable?

What do you think? Add your comments below.