"Expanding the Insurance Partnership is the Responsible Way to Insure the Uninsured Employees" by Julie Jennings

Last month, the Commonwealth Connector board discussed ways to cover 30,000 uninsured residents who can't afford health insurance offered by their employers. They are considering expansion of the Commonwealth Care program to address this population, in spite of the staggering budget projection of over $1 billion for fiscal year 2009, and the very strong likelihood that employees will start dropping their employer health plans to sign up for the subsidized Commonwealth Care plan.

For several years, an innovative program called the Insurance Partnership has been in existence. Employees of small businesses, where the employer contributes at least half the cost of their health insurance plan, can qualify for financial assistance from the state to pay their share of the health plan.

Until health care reform legislation was passed, eligibility was limited to those earning less than 200% of the federal poverty level. With Massachusetts health care reform, that income limit was increased to 300% of the federal poverty level, but was only made available to employees who were uninsured for the prior six months due to a 'crowd out' provision in the law. Additionally, larger employers with 51 or more employees and their employees are not eligible for the Insurance Partnership, regardless of whether their employees earned less than the 300% income level.

As a result, we have experienced a very lopsided approach to helping people obtain insurance in this state. Employees who earn between 200-300% of the federal poverty level have struggled for years to contribute to their employer sponsored health plan and their share of the increasing cost of insurance. They receive no assistance under MA health care reform because of the six month crowd out provision. Meanwhile, their co-workers who have the same income level, and who have gone without insurance and contributed to the free care pool costs for the past several years, are able to sign up for Insurance Partnership assistance.

Their neighbors, who also have the same income level, but who happen to work for a large manufacturer or retailer next door, cannot qualify for Insurance Partnership because their employer has over 50 employees. They must struggle to pay their share of their employer sponsored health plan on their own. Their co-workers, who also have the same income level, and work less than full-time hours for the employer, aren't eligible for their employer plan, but receive subsidized insurance through Commonwealth Care.

Before we think about expanding Commonwealth Care to people who have access to employer sponsored health insurance, we should look to expanding the Insurance Partnership to level the playing field among our productive employees in the commonwealth. If employees meeting the income limits qualify – regardless of whether they have insurance now or whether they work for the neighborhood donut shop or a major box retailer – the state should want to give them a hand in paying their share as long as their employers are willing to pay one half the cost of their health insurance plan. This plan is considerably less expensive to the state, and we wouldn't have to worry about people dropping their insurance to hop onto a state plan. This expansion of the Insurance Partnership has been recommended to the Legislature and to the Connector, and is an integral part of the position of the Massachusetts Association of Health Underwriters in promoting the goals of health care reform in a responsible way.

Julie Jennings, RHU, LIA, CLTC
Massachusetts Association of Health Underwriters, Inc.