What is Affordable Health Coverage? by Celia Wcislo

We are entering the most important phase of our work on healthcare reform this week. The Connector board will define what's affordable for working families and who will be required to buy health insurance. Consider the obvious and often reported facts we all know well: we have the third highest housing costs in the nation; the real value of the minimum wage is equivalent to what it was roughly 30 years ago; and we have sporadic job growth. And the number of uninsured is growing throughout the nation.

Determining what's affordable for the hard working families I know is enough to make my blood pressure rise. Regardless of what economists speculate, health care workers that I talk to are not sitting around with much cash in their pockets!

We need to proceed with extreme caution to truly fulfill the spirit of this law. We have already enrolled over 100,000 in either MassHealth, or Commonwealth Care. We should be proud of that. But we need to be asking ourselves "who is willingly participating?" We need to carefully evaluate the demographics of who has enrolled in Commonwealth Care thus far - before any mandate has taken effect - and see what this information tells us.

According to one insurer offering this Commonwealth Care, almost 79% of individuals enrolled are making less than 100% of poverty. The plans they are enrolled in have no premium cost. Folks making 100-200% now make up 17% of this plan. And only 4% of those who have signed up make 200-300% FPL. Now that's not a scientific survey, but it does show an obvious trend: the lower the premium rate, the greater the participation.

What stands out most is that over 200% FPL, participation drops off dramatically. Either we're not doing a great job reaching out to these individuals, or we have priced these plans to high and they are not seen as affordable. We need to dig into this data and find out. My guess is that the top level Commonwealth Care premiums are not affordable in the real world, irregardless of what an MIT data search might find.

Affordability is not just number crunching and academic trends. Our premiums must take into account the real costs faced by individuals and families. These costs include housing and utilities, food, healthcare, childcare, and education.

We want to make sure individuals and families can afford to purchase insurance that gives them medical security, but does not cause them financial insecurity.

We have come this far. Let's not fall down on the job now.Celia Wcislo, Assistant Division Director, 1199SEIU, MA Division
and member of the Connector Authority board