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YEAR-END OPEN ENROLLMENT IS NECESSARY FOR INCREASING THE NUMBERS OF INSURED by James Roosevelt, Jr.

I have enjoyed reading this forum for the past several months as there has been interesting, provocative and intelligent commentary on the early implementation of health care reform.

Let’s face it, though—most of the contributors and the readers are actively engaged in the political process, delivery of health care and/or health care coverage, and know full well that the Dec. 31 deadline for coverage is looming. But as John McDonough, executive director for Health Care for All, has recently pointed out in this forum, there is a tremendous need for education aimed at the working person who is barely aware of his or her responsibilities under health care reform. Moreover, there is even less awareness of the penalties that go into effect on January 1, for those who do not sign up for health insurance. November and December provide us with a unique teachable moment. We all—the Connector, providers, health plans, advocates and communities—must join with the media to raise people’s consciousness.

The Department of Revenue intends to highlight the issue when tax forms go out in January. That’s too late for people to avoid the penalty. In fact, enrollment by November 15 for a December 1 effective date is necessary to avoid the penalty. The legislature should permit enrollment effective January 1, to satisfy the mandate.

I firmly believe that most people would choose to purchase health insurance if they knew they had the opportunity—especially if they knew there were financial consequences if they did not.

In addition, as I have talked to many over the past months, I’ve discovered that there are a number of people who have access to insurance through their employers, but haven’t availed themselves of the coverage. These employees could enroll in non-group plans directly through insurers or through the Connector. However, many would receive better benefits and/or pay less toward premiums by enrolling in their employer’s plans, and they should be encouraged to do so with coverage effective by December 31.

What do we do?

First, we must use the time we have to engage in a dedicated effort of public education. I know the Connector intends to continue its broad-based public awareness campaign during the next months and I applaud its efforts. Tufts Health Plan has partnered with other not-for-profit health plans and the provider community to raise awareness through the Massachusetts Health Care Reform Coalition, and its efforts are ongoing. I also encourage the Department of Revenue to begin its public education campaign in this year, when it can still make a difference.

Second, we need to give people additional opportunities to obtain health insurance. Therefore, I propose that the Division of Insurance consider a special open enrollment in all plans to offer one more opportunity—when people are paying attention—to meet the needs of those who were unaware of the mandate. In fact, Gov. Patrick should also request employers of self-insured plans to make the opportunity available to their employees as well.

As we implement health care reform we will continue to encounter unexpected barriers. To make it work, we must be flexible and go the extra mile to ensure that our citizens have affordable health care and that they understand the consequences if they do not.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan.

This program aired on October 23, 2007. The audio for this program is not available.

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