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"Give to Caesar, what is Caesar's!" by Reverend Hurmon Hamilton

And Jesus answering said unto them, Render to Caesar the things that are Caesar's, and to God the things that are God's. And they marveled at him. Mark 12:17

When Massachusetts legislators passed our landmark health reform legislation in the spring of 2006, they left unresolved two critical questions, open to interpretation through regulation. One, what constitutes affordable and credible coverage for individuals for the purposes of deciding who is subject to the individual mandate? Two, what constitutes a fair and reasonable contribution for employers for the purposes of deciding which employers are subject to the $295 employer assessment? In the first case, the decision was left to the 11 member board of the Connector Authority, chaired by the Secretary of Administration and Finance. In the second case, the decision was left to the Division of Health Care Finance and Policy, under Commissioner Sarah Iselin and Secretary JudyAnn Bigby. For both critical decisions, it has fallen to the Patrick administration to sort out what amount is fair, reasonable, and affordable for both individuals and employers to contribute towards health care costs. This is no easy calculus.

The debate over what constitutes affordable and credible coverage has been robust and protracted. And because the Affordability Schedule has been tied to the premium schedule for Commonwealth Care, this debate promises to be renewed on an annual basis.

As a state, we are going to need to struggle with the reality that while premiums increase relentlessly every year, people’s ability to afford these premiums does not necessarily keep pace. The most recent increases in premiums for Commonwealth Care recipients – a minimum of 10% — was perhaps necessary for the fiscal solvency of the program, but requiring individuals to pay an ever increasing percentage of their limited incomes on health insurance in untenable in the long run. We cannot balance Commonwealth Care’s books on the backs of low and moderate income people; it is that simple.

Employers, particularly those who do not insure their workers, need to do their fair share if health reform is going to survive over the long haul. The Romney administration put out the first set of regulations governing which employers would be subject to the $295 employer assessment. Romney’s definition of “fair and reasonable” said that the employer must cover 25% of their employees or offer a contribution of at least 33% of employees’ premiums in order to avoid paying the $295 penalty. The Greater Boston Interfaith Organization, along with many others, petitioned the Patrick administration to change this standard to 50% and 50%; however, Governor Patrick preferred to wait and assess how well the Romney standard worked in year one of health reform.

A year’s worth of experience, however, suggests that the Romney standard raises next to no money – approximately $7 million. A year’s worth of experience also reveals a $130 million deficit in Commonwealth Care’s budget. Surely the non-insuring employer community should contribute at least as much to the Commonwealth Care budget as their employees are contributing through premium contributions. After all, employers whose workers are on Comm. Care are getting a real benefit by having the state subsidize their workers’ health care.

Based on this clear and compelling data, the Patrick administration has now promulgated draft regulations which adjust the definition of “fair and reasonable” to include both the requirement for employers to cover 25% of their employees and offer a contribution of at least 33% of employee’s premiums in order to avoid the $295 penalty. This change is short of the 50% and 50% change GBIO has advocated. However, the Patrick administration estimates this change will raise an additional $33 million for health reform, and we respect the administration’s intent to minimize any negative impact on businesses at the same time trying to fully fund health reform.

In the text above, everyone was amazed when Jesus settled a dispute by simply suggesting, “Render unto Caesar (civil government) the things that are Caesar’s...” I hope that the business community will not be sidetracked by the amazement that their turn has come to give the government a reasonable contribution to underwrite employer’s fair share of historic healthcare reform in our Commonwealth.

The Reverend Hurmon Hamilton
President, Greater Boston Interfaith Organization

This program aired on September 3, 2008. The audio for this program is not available.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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