Romney’s remark Monday about firing your insurance company apparently harmed him little yesterday in the New Hampshire primary. But as the quote has rocketed around, it might be misleading some into thinking that the Massachusetts health care reforms that Romney signed into law made it so people can willy-nilly get rid of an insurer that doesn’t pay their claims on time.
The comment deserves a second look. Can you really fire your insurance company? The answer is that it’s darn difficult even in Massachusetts—the land of Romneycare.
Sarah Kliff, The Washington Post’s health policy blogger, took a crack at explaining Romney’s remark. She argued that under Massachusetts’s individual mandate, which requires residents to carry health insurance, someone can sign up for a new policy only during an open enrollment period. That’s to prevent people from gaming the system by signing up for coverage only when they get sick. Insurance companies don’t like that since they end up insuring a bunch of sick people they might lose money on.
Kliff gave only half the answer. She was talking about people buying insurance on their own in the so-called individual market. But most people in Massachusetts have coverage from their employers. They, too, can, change insurers only during open enrollment, and their employer decides whether to offer policies from more than one carrier. And increasingly workers—and not only those in the Bay State—have less choice.
But what if they want to dump their employer’s policy because it’s too expensive or covers too little? Massachusetts law bars them from dropping that coverage and buying a policy through The Connector, the state’s shopping service, where they might find more suitable insurance. As long as their employer’s insurance meets some minimum state standards, they’re stuck.
When national health reform takes effect, the rules will get more complicated. Workers who have employer coverage cannot shop in the new state insurance exchanges and receive a government subsidy unless their share of the premium for employer coverage exceeds 9.5 percent of their gross income. If someone wants to leave an employer policy and doesn’t want a subsidy, they can shop in the exchange.
Romney’s statement prompts another look at Jeremy Devor, the man in the middle whose health insurance problems we’ve been reporting on. He would love to “fire” his insurance company, but can’t now or in the future. So you see, firing an insurance company is not exactly like giving a pink slip to bad employee—even if Romney thinks it is.
Both the Massachusetts plan and the ACA patterned on it are so contrived and convoluted that even Mitt Romney can't understand how they work. Do we think the general public will be able to navigate such a complicated system?And can they control costs in MA? When the exchanges and the subsidies are implemented, the insurers will still be taking our premium dollars to Wall Street, and, like Jeremy Devor, we'll all be stuck.
This whole market-based HC non-reform is so silly. We should be building on traditional cost-effective Medicare: simply improve and expand it to everyone.
No constitutional problem either!.
#1 Posted by Harriette Seiler, CJR on Wed 11 Jan 2012 at 05:36 PM
America has used it's best free enterprise tactics on our healthcare and turned it into the worst healthcare system of any developed country. Medicare returns 95% of the healthcare dollars it receives back to healthcare, whereas private, for profit insurers return as low as 68%.
To have a healthcare system that is truly affordable, equitable and accessible we need for Medicare to be enhanced and improved and available to all our citizens.
Harriett, I agree that silly is the word for the system we have and unfortunately that silliness has turned into a true healthcare crisis that is severely weakening our country.
#2 Posted by Bill Mahan, CJR on Wed 11 Jan 2012 at 06:14 PM
Thanks, Bob for posting a link to the voting results which MA state and national polticians have totally ignored.
Yesteday, a woman said on our local NPR station during Vox Pop that she would not vote for a Democrat after they rammed Obamacare through. And she mentioned that people in MA (she was a NY resident) are forced to pay for insurance they can't afford AND can't afford to use it.
I was glad to hear someone else say that publicly b/c I've been putting this out there for ages about the unaffordable to use mandated insurance, and I won't vote for a Democrat again for the same reason.
Medicare for All sounds catchy, but Medicare needs some serious improvement. I unenrolled in October b/c it's a bit pricey for the crummy coverage if you are on a fixed income plus you also have Part D to contend with. So, you choose between heating, eating and Medicare.
If you are dirt poor, you can get into Medicaid which covers what Medicare doesn't. If you are wealthy, you can afford Part B, D and a supplemental plan to cover what Medicare doesn't. If you are inbetween, you're in trouble.
SHINE counselors have said that many seniors can't afford the Part B amount that is taken from their SS checks and are struggling with this. Many also don't seek care b/c they can't afford the cost sharing. With Part D, they are still splitting pills or skipping dosages. Some have exhuasted their money supply and can't get access to care b/c of the way Parts A, B and D are set up.
Also, if you go to a doctor who doesn't "accept assignment," you will not only pay the customary 20 percent but will also be billed by the doctor for up to 15 percent of the Medicare-approved amount. That can be quite expensive.
I noticed in the booklet that Medicare doesn't pay for pre-diabetes, only full blown, and the necessary paraphernalia comes under Part B, so is 80/20. Expensive. Forget trying to nip diabetes in the bud when someone is pre-diabetic. Prediabetes nutritonist visits or courses in management are also not covered. So this increases health care costs for the gov't as well as the patient.
RX from Canada is cheaper than Part D.
So best to say: IMPROVED Medicare for All - emphasis on Improved.
#3 Posted by dianne, CJR on Thu 12 Jan 2012 at 02:10 AM
@ dianne
You are correct that "Medicare needs some serious improvement." Your comment says you "unenrolled in October." I hope that was a typo but taking you at your word -- and you imply that you live in Massachusetts -- please consider re-enrolling.
I assume you mean you unenrolled from Part B, which costs $100 a month in 2012. Part A is "free" (not counting the taxes you paid for 40 years) for almost everyone but also iis "crummy" with high deductibles and life time limits. And don't get sick when you go to Canada to get a prescription; you won't be covered by Medicare. (Maybe you meant you unenrolled from a supplement which would take a longer explanation than I can make on this comment.) .
.
You do not have to be "dirt poor" to get premium assistance through MassHeatlh (Medicaid). There is some assistance in Massachusetts for those individuals with income up to $25,000 with no asset test and you could get your Part B for free even if receiving as much as $15,000 in SS if your assets are less than $7000. There are also generous benefits for veterans and famililes, including widows (this is state aid, not VA).. I am a volunteer SHINE counselor and we are almost always able to get a struggling senior into one of these programs.
Don't go to a doctor who doesn't "accept assignment." There only a few in Massachusetts????
#4 Posted by dennis byron, CJR on Thu 12 Jan 2012 at 04:24 AM
Yahoo's Daniel Gross wrote an excellent piece on Romney's real gaffe in making that firing remark:
http://news.yahoo.com/blogs/ticket/real-problem-romney-fire-people-gaffe-160257883.html;_ylt=AqoXPDZ_N_uiA_Aek5ipAnM6_Od_;_ylu=X3oDMTRpNTEzbDl0BG1pdANFbGVjdGlvbnMgMjAxMiBTZWN0aW9uTGlzdCBUaWNrZXQEcGtnAzM1MTY4ZDQzLTBlYWEtM2I5NC1hMjZjLTYzZTE0MzBmMjhjNgRwb3MDMwRzZWMDTWVkaWFTZWN0aW9uTGlzdAR2ZXIDNWJmNzYxMDAtM2JhZi0xMWUxLTg3ZWEtNGJjNWZmYzQwNzYz;_ylg=X3oDMTJjMjRsb3ZrBGludGwDdXMEbGFuZwNlbi11cwRwc3RhaWQDBHBzdGNhdANwb2xpdGljc3xkZXN0aW5hdGlvbjIwMTIEcHQDc2VjdGlvbnMEdGVzdAM-;_ylv=3
#5 Posted by Harris Meyer, CJR on Fri 13 Jan 2012 at 03:02 AM
What stands out to me about Romney's remarks is not the regulations of Massachusets health care or federal health care laws, is that it underscores that Romney does not live like the rest of us. The vast majority of people are part of a group plan either through work, their union or association, COBRA, Medicare, Medicaid or any other government option. We do not individually hire or fire our insurance companies. Only the independently do that.
#6 Posted by Joy Schulman, CJR on Fri 13 Jan 2012 at 04:11 PM