Time to sign up for a health plan

David Taber

It took three years to construct the statute mandating health insurance for every Massachusetts citizen, and countless months to develop the infrastructure officials are hoping will make the process painless. Now it’s time for residents to sign themselves up.

That was the message representatives from the Commonwealth Connector Authority (CCA) and the advocacy group Healthcare For All (HCFA) had to share at a June 6 Health Care Forum hosted by the Ward 19 and Ward 11 Democratic Committee’s at English High School.

The state estimates over 300,000 Massachusetts residents living without insurance at this time last year. Of these, about 79,000 have signed up for Commonwealth Care, the state’s new subsidized health insurance program, since it was unveiled last October. But, those were probably the easy ones, said Jennifer Chow, Outreach and Enrollment Manager for HCFA, said. “The people who signed up this year were ready. They were following what was going on and they signed up right away. This year there is going to be much more to do.”

Commonwealth Choices, the apparatus by which the state hopes to connect people who it says can afford market-rate coverage with approved plans, recently went on-line.

The success of either of these programs, and of the Commonwealth’s experiment in offering citizens access to coverage, is dependent on individual participation, CCA Associate Eric Dahlberg told the crowd of about 30 people in the Boston English Auditorium. “The grand philosophy is one of shared responsibility. Individual responsibility has a role to play, state government has a role to play, and employers have a role to play,” Dahlberg said.

At the beginning of the forum, which was taped by the Boston Neighborhood Network cable-access station, Dahlberg joked about the small size of the crowd. “For those of you [in the television viewing audience] who can’t see, the room is bursting at the seams. It is like Fenway Park on game day,” he said.


Although July 1 is the official deadline for residents to have acquired a healthcare plan, financial penalties for failure to enroll will no affect anyone who gets a plan before Dec. 31, 2007.

“We do not want this process to be punitive. We want to give everyone the opportunity to adjust, to get up to speed on this,” Dahlberg said.

The only penalty for not having health insurance by the beginning of the 2008 calendar year is the potential loss of one’s personal exemption on their state income tax, to the tune of about $220, Dahlberg said.

At the end of 2008 there will be a 63-day grace period and then, “the penalty tightens up,” Dahlberg said. Those who fail to secure health insurance by the end of next year will be accessed and charged a fine equal to half the cost of the cheapest healthcare plan they would be able to afford over the remaining ten months.

While the healthcare plan aims to be comprehensive, people will be able to appeal for exemption based on affordability, hardship, or sincerely held religious beliefs.

Commonwealth Care

Commonwealth Care, the states subsidized plan will be available for people who are not insured by am employer and whose household income is less than 3 times the federal poverty level (FPL), or $30,636, yearly for an individual. As of July 1, those making less than 150 percent of the FPL will be eligible for completely subsidized care. Those making 250 percent to 300 percent of the FPL will be eligible for a plan that costs about $105.

Individuals are considered uninsured unless they have been offered health insurance by their employer in the last six months that covers 20 percent of the annual premium cost for a family or 33 percent of the premium cost for an individual. Employers with the equivalent, in hours worked, of 11 or more fulltime employees are required to offer insurance to their fulltime employees.

Part of the motivation behind the Commonwealth Care program was to take the burden off of the Commonwealth’s free care pool, Chow said. All taxpayers contribute to the uncompensated care pool (sometimes known as free care), and it is used to compensate hospitals when uninsured patients are unable to pay for their healthcare.

“If free care costs decrease over the years, the tax burden will weigh less heavily on us as taxpayers,” she said.

Commonwealth Care will only be available to US citizens, but immigrants will still have access to the free care pool, Chow said.

To begin the process of signing up for Commonwealth Care, call Health Care For All’s Helpline at 1-800-272-4232.

Commonwealth Choices

Commonwealth Choices, a program for residents determined to be able to afford health insurance (e.g. an individual who makes more than $30,636), is not a health insurance plan itself, Dahlberg said, but a clearinghouse for state approved insurance plans.

Dalhberg described the program, which recently went on-line, as “the Travelocity of health insurance, or the amazon.com of health insurance.”

The Connector authority has selected six health insurance carriers, and has split the various plans they offer into gold, silver and bronze levels, with gold being the most expensive and comprehensive level of coverage, Dahlberg said. Costs vary within these levels depending on the age of the uninsured, and there is also a separate level of coverage available to those between the ages of 20 and 26.

Employers who provide their employees with health insurance have the option of offering to subsidize a portion of their employees cost through the Choices program.

Those interested in getting information about and enrolling in Commonwealth Choices plans can do so at www.mahealthconector.org.

Will it float?

As of May, about 100 people a week were enrolling in Commonwealth Choice plans. New numbers will not be available until July, but it is projected enrollment will pick up. Revenue the choices program generates is slated to fund the Commonwealth Connector’s operational costs, Dahlberg said.

“We are going to survive on fees we generate. We are going to operate like a business,” he said.

The Connector is planning to net between $1.16 million and $2.089 million of their almost $30 million dollar budget from the choices program. They project they will net between $21.3 million and $23.3 million from fees for the administration of the Commonwealth Care program. Right now, they project they will end the 2008 fiscal year, which starts July 1, with a net loss of about $8 million.

Commonwealth Connector Spokesman Dick Powers said the Connector has established a line of credit, but has not had to tap into it yet.


Chow said a two-pronged approach is being undertaken to get the word out about the state’s new system.

Twenty-four community organizations across the commonwealth have relieved grants from the state to do outreach work, she said. Some are focusing on regional communities, and some focusing on specific groups like the HIV positive population or different immigrant populations, will be doing outreach work and helping people enroll in the programs. Other non-profits are developing broader, statewide campaigns.

Meanwhile, “The Connector Authority has hired PR firms that are doing broad-based marketing campaigns,” that will include billboards and TV and radio commercials, she said.

But will they be able to get everybody enrolled?

Dahlberg, pointing out that, according to the state’s own estimate, Massachusetts, at 6 percent has “the least number of uninsured people in any state in the union,” said he thinks so.

“If any state can do this, I am confidant it is Massachusetts,” he said at the beginning of the forum.

Then, during the question and answer period, he offered a slightly different perspective. “It is the law of the land, and that is how we are going to operate,” he said.

State Rep. Liz Malia, who attended the forum, said she expects to see a rush of applicants as the Dec. 31 deadline approaches. She admitted she is only just informing herself about the ins and outs of the new system, but “it has to work, we have to make it work,” she said.

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