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Q&A: The Mass. Health Insurance Battle

Health insurance rates are at the heart of a legal battle brewing in Massachusetts. Insurance companies were in Suffolk Superior Court on Thursday asking a judge to rule that the state went too far when it rejected their proposed rate hikes last week. A decision is expected by Monday. To talk about what this means for regular folks, WBUR's Morning Edition host Deb Becker had this conversation with WBUR's health and science reporter Sacha Pfeiffer.


What kind of problems are people facing as a result of this showdown between the insurance industry and the state? Are some people still not getting insurance?

First of all, the people affected mostly work for small businesses, although there are some individuals, too. And to find out how they're dealing with this, I called Health Care for All, a Boston nonprofit that has a telephone help line for anyone with questions about the state's health care system. It gets about a thousand calls a week. Amy Whitcomb Slemmer, the group's the executive director, says that this week that help line is getting calls from lots of worried people.


We heard from a consumer who had just completed her trial period at her job, had a 90-day waiting period, and she became eligible for insurance on Wednesday and she is not able to buy it.


Amy Whitcomb Slemmer, Executive Director, Health Care for All


Slemmer says that woman is currently uninsured. So even though she finally qualifies for health insurance, she can't get it. And that can obviously cause a lot of anxiety.

An irony here, of sorts, is that health insurance is now mandatory in Massachusetts because of the health reform law the state passed in 2006, correct?

Exactly. Slemmer points out that this is a woman who not only wants to buy insurance, but that she's violating the law if she doesn't buy insurance. And because of a dispute in the courts that's completely beyond her control, she ends up the victim.

In Massachusetts we require everyone to have health care coverage, and yet this week there are a whole group of consumers who can't buy it. Their health care is being held hostage by insurance companies that aren't selling.

Amy Whitcomb Slemmer, Executive Director, Health Care for All
Now, some of the insurers have started selling again, but people's options are still limited. And it's unclear for now what the new premiums will be. The insurance companies say they have to raise rates because health care costs have gotten so high.

Do we know if that's true? Because state regulators say the rate hikes were excessive.

We could probably spend an hour talking about that alone. Because the cost of health care, and why those costs are rising, is at the very heart of this debate. It's part of what was argued in court yesterday and it's what state policy makers may eventually have to decide. For now, the answer depends on who you talk to, and it's a very heated question.

Speaking of costs, Massachusetts created a special commission that last year recommended ways to cut health care expenses. Have any of those ideas been adopted?

It's now up to the state legislature to take those recommendations and try to create a law that incorporates them. So far that hasn't happened. But this week's events really ratchet up the urgency to get a bill written and passed.

Given that Massachusetts health care reform was the model for national health reform, could we eventually see this kind of stand-off on a nationwide level, too?

I asked Slemmer that question, and she said she isn't sure. But she did say this legal fight could again put Massachusetts at the cutting edge of figuring out the next step of health reform. And that's not just the question of how to provide health care to everyone, but how to provide high-quality, affordable health care to everyone.

I believe as we get through this current hiccup of not having health insurance available to consumers, I think there will be terrific lessons learned for the rest of the country as they, too, are trying to figure out how to address the cost and quality challenges.

Amy Whitcomb Slemmer, Executive Director, Health Care for All
So that's the hopeful perspective, at least.

This program aired on April 9, 2010. The audio for this program is not available.

Sacha Pfeiffer Twitter Host, All Things Considered
Sacha Pfeiffer was formerly the host of WBUR's All Things Considered.

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