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Writer Mike Mennonno visited his local clinic for a checkup and was told he could sign up for Commonwealth Care. He expected to get a bill for an $18 premium. Instead he got one for $662. For a cholesterol check. "It just seems a little steep, is all," Mennonno wrote on his blog. After many calls, things turned out okay with the bill. Then this year Mennonno was asked to reenroll and send in his tax forms. So he did-and was told that his pay stubs, not his tax forms, were required. Now he might be fined for not enrolling in time. Mennonno says that paying the fine might be a bargain compared with dealing with the state agency that runs Commonwealth Care. At least his cholesterol was fine.
In the end, however, it's probably the tough economics of universal health care that might make a plan like Mas_sachusetts's hard to stomach for a lot of the country. You can go back to Stephen Gore to see why.
Gore, as it happens, found another job several months after signing up for Commonwealth Care. Still, he thinks the state program was a boon. "I was able to keep my sanity," he says, and that made it a lot easier to find a job. "There's nothing," he points out, "like a crazy person showing up at a job interview." He went into interviews more relaxed, expanded his search, and soon had a job running a computer help desk, a step up from his old one.
Gore's new job provided health insurance from day one. If it hadn't-or worse, didn't provide insurance at all-he and his wife would have had to buy their own. Gore's new income would have meant that they were no longer eligible for inexpensive state-subsidized rates; they'd have had to buy their insurance at full price. Even the least expensive plan available through Commonwealth Choice, the state's list of individual plans offered by six nonprofit insurers, would have cost $783 a month for him and Robin, and that would have come with a $2,000 deductible for each of them. Mulling over those numbers, even Gore, a big fan of the Massachusetts system, concedes that with his current paycheck, that would have been a lot of money. He's glad that with the benefits at his new job, figuring out whether he and Robin could afford the state's insurance mandate isn't something he had to do. "I'm thankful it didn't come to that," says Gore.
There, in a nutshell, is the big quandary of universal health care: A system like Commonwealth Care that includes subsidies for some is likely to seriously stretch the resources of others.
The ultimate test of the Massachusetts experiment may be not in how effectively it manages to provide care for those who can't afford insurance on their own, but in how well it does in getting all the others to buy in.
As of today, Stephen Gore remains cancer free.
If you live in Massachusetts, you have to sign up for health insurance. It's the law. People with incomes at or below 300 percent of the poverty level qualify for subsidized insurance from Commonwealth Care. People who make more than this must have insurance through work or a private plan (six nonprofit insurers offer coverage in a program called Commonwealth Choice). If they don't sign up, they face a fine (actually a tax penalty). The cost of staying healthy-and ahead of the law-in Massachusetts:
Annual Income (at or below): $15,612 (individual)
Lowest Monthly Premium: $0
Fine for Failing to Sign Up*: $0
Annual Income (at or below): $31,812 (family of four)
Lowest Monthly Premium: $0
Fine for Failing to Sign Up*: $0
Annual Income (at or below): $20,808 (ind.)
Lowest Monthly Premium: $39
Fine for Failing to Sign Up*: $210
Annual Income (at or below): $42,408 (family)
Lowest Monthly Premium: $78
Fine for Failing to Sign Up*: $420
Annual Income (at or below): $26,016-$31,212 (ind.)
Lowest Monthly Premium: $116
Fine for Failing to Sign Up*: $630
Annual Income (at or below): $53,016-$63,612 (family)
Lowest Monthly Premium: $232
Fine for Failing to Sign Up*: $1,260
Annual Income (at or below): More than $31,212 (ind.)
Lowest Monthly Premium: must have private insurance, such as Commonwealth Choice
Fine for Failing to Sign Up*: $672 annually if 26 or younger; $912 annually if 27 or older
Annual Income (at or below): More than $63,612 (family)
Lowest Monthly Premium: must have private insurance, such as Commonwealth Choice
Fine for Failing to Sign Up*: $1,344 if head of household is 26 or younger; $1,824 if head of household is 27 or older
*PENALTIES FOR THE 2008 TAX YEAR ARE BASED ON PLAN PRICES AS OF JANUARY 2008.
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