Massachusetts has just begun an historic experiment in health care coverage. As of July 1—just two days after the nationwide opening of SiCKO—everyone 18 or over in the state was supposed to have health insurance or face possible loss of their personal income tax deduction.
The goal: to have no citizens of the commonwealth uninsured. As they like to say inside the Beltway, no one left behind.
Of course, nothing about such an enormous undertaking is simple. Only two paragraphs in, we have to back up and start qualifying things. It's not exactly true that everyone had to have insurance on July 1. To be more precise, July 1 is the day the healthcare reform law requiring people to be insured takes effect; uninsured residents actually have until December 31 to choose their program and sign on.
The difference between the effective date and the actual deadline has been somewhat befuddling to everyone, but what's more important than figuring it out is for those needing insurance to get on www.mahealthconnector.org. and start doing the calculations laid out by the site's Affordability Tool. The tool is designed to guide people in their search for insurance they can pay for (for example, the commonwealth in its wisdom has decided that a family bringing in $45,000 a year should be able to pay a premium of $210 a month, but if someone is disabled, the equation may change), or to let them know if they belong to one of a very few classes of Massachusetts residents who are exempt from the insurance requirement. Those who must get insurance but have incomes below 100 percent of the poverty line will not be required to pay premiums.
Employers also have new responsibilities. Those employing 11 people or more must make "fair and reasonable" contributions to their full-time employees' health coverage costs. They must also set up a mechanism (called a Section 125 plan) through which all their employees can pay their health insurance premiums on a pre-tax basis.
The new program is moving forward in spite of many unknowns, which include the answer to that most basic of questions: how many people in Massachusetts are uninsured? The state says 372,000 (328,000 between 18 and 64); the federal Centers for Disease Control say 601,000 (524,000 between 18 and 64). That means it's a guess how many will enroll in Commonwealth Care, the new program for insuring low-income residents, and whether the actuarial assumptions undergirding that program will hold true.
How many cases the new law will take out of the uncompensated care pool—the fund that until now has paid for medical care for those who could not afford it—also remains to be seen; the good news is that some of the burden seems to have been taken from that pool already, now that 80,000 previously uncovered Bay Staters have signed up for coverage.
An eleventh-hour change to the law allows artists and other self-employed people to use their income minus allowed business expenses, rather than their gross income, to determine how much they should pay for insurance.
For guidance through the maze of the healthcare reform law and help to get started finding a plan, another resource is the Health Care For All Health Helpline at (800) 272-4232.
On the SiCKO Trail
Why does Cuba, a nation with an extremely austere economy, have one of the healthiest populations in the world? Why are 100 Americans and thousands of others from all over the world studying medicine there? How does Cuba manage to send tens of thousands of health care professionals to work as volunteers in other countries?
It's too late to get on the boat and travel to Havana with Michael Moore and his ailing 9/11 rescue workers, but to learn more about the Cuban health care system he explores in SiCKO, see ¡Salud!, a feature documentary by Academy Award nominee Connie Field (Freedom On My Mind, The Life and Times of Rosie the Riveter) and Gail Reed, with commentary by former president Jimmy Carter and Harvard Medical School professor and international health consultant Paul Farmer.
¡Salud!, which also includes an overview of the global fight for health care for the poor, is part of the Wide Angle Films series. It will be shown July 20 at 7 p.m at the Unitarian Universalist Society, corner of Kellogg and North Pleasant streets in Amherst. Admission is free; donations are welcome.
For more information, check http://justiceandpeace.net/WideAngleFilms.htm or call 413-256-1760. "
