ROW HARDER by Celia Wcislo

"Row harder." That's what some are saying to poor and sick consumers who they want to hit with large co-pay and premium increases, intended to cover financial gaps faced by the Connector due to successful enrollment efforts.

Locally and nationally, rough fiscal waters are ahead for healthcare. Threats by the federal government to further decimate funding for children's healthcare and Medicaid loom like a black cloud over our state's noble first-in-the-country healthcare experiment.

The time is now for new, big ideas about how Massachusetts keeps healthcare reform on course. Consumers, taxpayers, and the state are doing their share of the rowing. It's time for businesses, insurers, and hospitals to grab an oar.

A recent Boston Globe editorial asked, "If people on limited incomes must pay more, why not employers?" It's an important question at the right time. It should also be applied to insurers and hospitals. The $295 fee employers who fail to offer affordable insurance must pay is a paltry sum, in light of what is now being asked of Connector insurance enrollees, the state, and taxpayers. If consumer rates go up, so should assessments for negligent businesses. The state should also revise the anemic regulations that determine which employers are obligated to pay assessments.

Right now, only 33% of employees at a business must purchase the employer-provided healthcare for that business to avoid paying special assessments fees to the Connector program. It's time to raise that bar, so there is a real incentive for employers to offer affordable plans which at least half of their staff will choose to purchase. The Romney administration predicted $55 million in revenue would be generated from negligent employer assessments to offset healthcare costs for consumers and taxpayers. Due to the weak 33% standard, only $6.2 million has been collected through these employer assessments to date. That's a big hole in an even bigger bucket - one that no amount of cost-shifting to consumer or individual taxpayers will ever fill.

In contrast to proposed co-pay and premium increases for consumers, hospital and insurer contributions to state-subsidized healthcare have remained flat since 2005. In fact, large hospital systems and insurers continue to reap financial gains from the system. Over three years, healthcare reform will bring in over $540 million in new taxpayer-funded reimbursements for hospitals. Meanwhile, the amount of charity care hospitals provide the community is declining rapidly, because more of their patients are coming through the doors with insurance. It's evidence that healthcare reform is working, but it's also evidence that the powerful Boston teaching hospitals are in a position to contribute more towards the future success of reform.

In 2007, major Boston teaching hospitals held nearly $9 billion in unrestricted net assets, an increase of $2 billion, or 30%, from the previous year. Major Boston teaching hospitals hold $16 billion total in assets. If hospital assessments were simply increased at the rate of healthcare inflation, it would be a significant step towards filling the current fiscal gap facing reform, while alleviating mounting pressure on consumers and taxpayers.

There's plenty of opportunity for insurers to row harder, too. According to recent reports, Blue-Cross and Blue Shield chairman William C. Van Faasen was paid $16.4 million in retirement benefits in January 2006. That's more than double what the proposed premium increases for thousands of Massachusetts consumers would yield the state this year, if the proposed Connector insurance fee hikes are accepted in their current form.

The proposed course of dramatic cost-shifting to consumers, the state, and taxpayers is neither a short-term nor a long-term solution for funding healthcare reform. Why must working families and taxpayers shoulder the burden alone? Clearly, new revenue sources from hospitals, insurers, and from businesses who fail to provide affordable coverage to their employees, must be considered.

A sense of shared responsibility is what has made reform a success thus far. That sense of shared responsibility must not be allowed to erode. With rough waters ahead, simply asking consumers, the state, and taxpayers to row harder won't cut it. Hospitals, insurers, and businesses must embrace an "all hands on deck" approach and pay their fair share to keep this honorable first-in-the-nation experiment on course.

Celia Wcislo
Assistant Division Director, 1199SEIU
and Connector Board member