A few reasons why the Massachusetts "universal healthcare" implementation isn't working

There's a lot of talk in the blogosphere about why the Massachusetts universal healthcare thing isn't working. I thought I'd throw in my two cents based on my experiences:

(For the record, I'm totally in favor of universal healthcare. This state just obviously doesn't know how to implement it.)

1) The state is only penalizing companies that don't offer ANY healthcare. They're not penalizing companies (like my employer) that offer unaffordable insurance. My agency does subsidize the insurance a little bit, so it costs less than purchasing comparable insurance on the MA connector, but it still doesn't cover much. You know that "affordability worksheet" that's in your MA tax form booklet? When I fill it out, it tells us that our income is sufficient to afford a plan that costs X per month. The cheapest plan my employer offers me costs a lot more than X per month. So, if I were to decline insurance, I wouldn't be penalized by the state since I'm not offered affordable insurance (and don't make enough to be required to buy full-price insurance privately), but my employer also is not being penalized for offering me an expensive plan that covers nothing. So, all a company has to do to avoid this penalty is to offer health insurance, even if they don't subsidize it whatsoever.

2) When universal *cough*bullshit*cough* healthcare started up in Massachusetts, the state eliminated the plans that were previously in place. For instance:

2a) MassHealth no longer considers people to have a disability if said person is able to work, or is working. (Those are actually somewhat different; their doctors agreed that I'm unable to work by standardized measures, but in my case my level of education and skills make me lucky enough to have a job where I can flex my hours and reschedule things when I can't make it in, and I don't have to do much physical labor as a white-collar type, so I have been consistently employed.) In Massachusetts, one can only get Medicare based on disability if one is totally unable to work and not working. There are a few exceptions for diagnoses like Down Syndrome. Many other states have a "medically needy" category where employed people with a lot of medical expenses can get Medicare and still work.

Despite having conditions that cost me a buttload of money in medical expenses and substantially affect my daily life (again, by standard measures; I personally find ways to do what I need to), I can't get any help from MassHealth unless I stop working. If I were to stop working, they would give me SSI, SSDI, and MassHealth.

I'd be better off financially if I stopped working. How messed up is that? All I want them to do is give me MassHealth to help with my large and frequent co-pays and cover things that my work insurance doesn't cover, like leg braces (When I called my insurance company to see if I could get an exception, they told me that they don't cover that sort of stuff because people who need it can get Medicare. Except not in Massachusetts, I discovered.), MRIs and bloodwork. They aren't willing to do this, but they're willing to pay me to sit at home and not work. Tell me, which is more cost effective?

2b) I have a lot of out-of-pocket medical expenses related to some chronic medical conditions. I pay a lot of co-pays for meds and frequent specialist visits (plus my co-pays particularly suck because one of my conditions requires that I go to the ER and get IV drugs any time I have symptoms, and the ER is $100 per visit) and I pay out-of-pocket for stuff that my insurance doesn't cover. There have been recent years that my medical bills were up near my yearly salary. (I've not paid them, and they've gone to collections and ruined my credit.)

Before they had the universal healthcare thing, hospitals ran their own freecare systems. I used to just go into their financial aid office, show them my medical bills that were close to my yearly income, and they'd agree to cover them since there was clearly no way for me to pay them. Now, the hospitals can't do their own freecare, and those funds are instead under the state "safety net" program, also administered by the MassHealth people. This program only looks at your yearly income, not anything else. Since my yearly income is a bit above their close-to-poverty limits (which are somewhere in the 20,000s for our family), they can't help me. It doesn't matter that my outstanding medical bills last year were close to my yearly income and I obviously can't pay them and also have housing or food.

Also, to add in a few thoughts about why this particularly burdens GLBT families:

My employer only offers single-person insurance plans and family insurance plans. (A majority of employers in the area offer two-person plans, according to surveying that has been done by the GLBT media). Since the federal government refuses to recognize my same-sex marriage, I pay extensive federal taxes on my health insurance plan, and the family plans make this even worse for my spouse and me. When I pay $312.87 per month for insurance premiums, the IRS considers $111.34 of that (the cost of the individual plan offered to us) to be allowable as a pre-tax deduction. I then have to pay taxes on the additional $201.53, since the federal government does not allow me to spend pre-tax dollars on my spouse. My spouse then has to declare the $201.53 as taxable income, for the same reason. The guidelines state that the entire amount paid above the amount of an individual plan is taxable for both of us; we are not allowed to discard the additional amount that we are forced to donate to my employer. Not only are we subsidizing other people's larger families, but we're being taxed on this donation as if it were income. We're paying the price for being forced to have a family plan THREE TIMES, not just one time like opposite-sex two-person families. If my employer were to offer a two-person plan costing roughly $200 per month, my spouse and I would each only be taxed on the additional $100 or so per month, rather than the $200 we pay taxes on because of the family plan. Having a two-person plan would reduce each of our taxable incomes by about $1200 per year, while increasing our available take-home income by about the same amount. Gay and Lesbian Advocates and Defenders (GLAD) has written a number of papers explaining why refusing to offer a two-person plan unfairly burdens same-sex couples.


Jodie said...

In today's New York Times:


I thought it was time considering your entry here!

eeka said...

Ooh, cool article. And yeah, the issue of whether healthcare falls into a loophole is really convoluted. No one seems to be able to figure out the correct answer, including the IRS. At one point when I called them, they said I would need to enclose with my taxes some numbered form (they told me the number...) from my employer stating that my employer had allowed me to use pre-tax dollars on insurance for someone who isn't my legal dependent. Of course, I went and talked to Awesome Payroll Gal, and she tells me that of course they don't have any such form, because they don't allow people to use pre-tax dollars on people who aren't legal dependents. She told me that even before legal marriage in MA, there were all those laws that essentially amount to common-law (only real difference is that this state doesn't actually have common law, so they don't decide that people who've jointly supported one another are legally MARRIED based on that, so it can't work against you but works for you in financial etc. situations), so no employer in this state ever was issuing any form saying that a domestic partner isn't a dependent, because that's just not true.

Um, so since I can't get myself a copy of said damn form, I can't seem to find a way to file taxes on Molly's insurance benefits. She also can't get a copy of a form saying she was given a random gift of health insurance from some stranger's employer, so also no way to file taxes on it.

Still, if the IRS ever does decide to bill us for taxes on it, they'd be sending us bigger bills than if it were a two-person plan instead of a family plan.