How would you define affordable health coverage?

Here's our story on the Connector board discussion yesterday about how to define "affordable" within the state's health insurance law. We'd love to hear your thougthful comments.

On the one year anniversary of an agreement that launched the state's
universal health insurance law, there are marked differences about how
to define a central element of the law: affordable coverage.

The definition is key because the requirement that individuals have
health insurance only applies if affordable coverage is available.

The Connector Board began discussing "what is affordable" yesterday with
two contrasting views, as WBUR's Martha Bebinger explains.

The audio for this story will be available on WBUR's web site after
10 a.m. on Wednesday.

TEXT OF STORY

MARTHA BEBINGER: On the one hand, the board heard from MIT economics
professor Jonathan Gruber who says let's define affordable as what people
are already buying voluntarily. He says only seven percent of employees
nationwide who are offered health insurance in the workplace turn it
down. His conclusion is that new health plans the uninsured will be
able to buy starting next month are largely affordable.

JONATHAN GRUBER: The strongest evidence is that people, even low income
people, are currently buying health insurance.

BEBINGER: The Connector board must also decide what is affordable for
residents who qualify for subsidized health insurance. Gruber, a Connector board member, says that most people in that group, who earn less than $30,000 a year, report some miscellaneous spending.

GRUBER: The vast majority of people below three times poverty do have
room in their budgets to pay for Commonwealth Care premiums.

BEBINGER: While Gruber argues against waiving penalties for not having
insurance for any income groups, Christine Barber with Community
Catalyst, says that residents who earn less than that $30,000 a year can
afford little more than life's necessities, and should be exempt. For
residents who must buy coverage on their own, Barber recommends a
sliding scale that starts at about $100 dollars a month for those who earn $30,000 a year and goes up to $420 a month at $60,000. Barber
says the state might ask more of residents after the law has been in
effect for a few years, but should give the uninsured more of a break to
start.

CHRISTINE BARBER: It's a new idea, its something that hasn't been tried
yet in the united states, we're not sure how the public is going to
accept this. So rather than coercing people to buy insurance and have
them face financial penalties, we want most people to voluntarily chose
to buy insurance.

BEBINGER: The proposal would exempt more than half of the state's
uninsured residents who earn less than $30,000 a year, although more than a third of that group has already signed on for free or subsidized insurance. Business leaders say that sweeping exemptions for uninsured individuals would undermine the shared responsibility premise on which the law was founded. Connector director Jon Kingsdale says it might also drive up the cost of coverage for the uninsured because those who are sick and need a health plan would be more likely to buy one than those who are healthy. Kingsdale says that would make it more difficult to provide affordable commercial and government
subsidized health insurance through the program called Commonwealth
Care.

JON KINGSDALE: To spend a half billion dollars next year on making
Commonwealth Care accessible and then determine, but it costs too much
to be affordable, would be a prescription for moving away from/the
intent of this reform.

BEBINGER: The board is scheduled to vote on draft affordability
guidelines a week from tomorrow. Connector board chairwoman Leslie Kirwan
says she isn't sure yet if she support waiving penalties for uninsured
residents in low to moderate income groups.

LESLIE KIRWAN: How many people can we allow to fall outside of the
mandate and still be achieving the core intent of health care reform,
and that's what we're going to struggle with as a board.

BEBINGER: Uninsured residents will have the option of appealing whatever
the board decides is affordable. The Connector has not decided on a
process for reviewing and settling those appeals.