As the National Program was largely based on the Massachusetts Model, one should note that Massachusetts offers an exception from penalty, or, an opt-out of sorts, for residents who either cannot afford to purchase health insurance and/or refuse for religious reasons. To avoid the penalty, each year, the resident must file for an exception with the State’s Department of Revenue, (Commonwealth Version of the Internal Revenue Service), that agency then forwards the request to the Mass. Health Connector, who reviews the application for exception and based on a series of financial hardship hurdles, will waive the penalty for that year only.
The penalty from the States D.O.R., is put “on hold” until the Connector makes a decision as to exempt or not exempt an individual request. Should the State find for the State, then the individual can further appeal the decision in court. Instructions for filing an exception are available at the Mass Health Connector portal.
In using the Massachusetts “Tool” to find if one is eligible for an exception, one will need: a prior year’s tax form and or estimate of total income, one is then given the standards for minimum coverage allowed under the State Mandate, and then given income levels that determine if one is eligible for exemption:
Question 2 - Is your annual income greater than:
• $54,600 if you are an individual
• $85,800 if you are a married couple without children or
• $114,400 if you are a family (at least one parent, one child/dependent)?
If one answers yes, they are immediately given the option to Estimate their tax penalty, as well as the option for filing for an exemption due to hardship by going to the “Waivers from the Tax Penalties: What They Are. How to Get Them.” page. The lengthy list includes exceptions for the homeless, for those who do not meet federal poverty guidelines, for those who’ve suffered a natural disaster, as well as the following:
“What else qualifies as a hardship?
Large families may claim that the Affordability Schedule does not fully account for their financial burdens. We will also consider other claims.”
What qualifies as “other claims”, is not specified, however, more than one resident has used this “last resort” qualifier to avoid paying the penalties.
In other words, Massachusetts mandates one has coverage, however, also offers residents (who must jump through hoops, submit forms, and deal with two agencies) in order to avoid paying fines, or being forced to buy health insurance a way out. Massachusetts, therefore, as a model, on the one hand mandates and fines, and on the other, exempts those who can find the information regarding exceptions
As to the cost of administering the behemoth that is Mandated Health Care Massachusetts Style, takes up the majority of the State Budget. The lack of ability to streamline, by cutting the process to a one-agency stop, allows the Commonwealth to hire additional staff to handle the claims.
The total system according to the CATO Institute is a dismal failure. The article, written in 2008, notes the following on the programs “universal coverage”:
The subsidies may have increased the number of Massachusetts citizens with insurance, but as many as 400,000 Massachusetts residents by some estimates have failed to buy the required insurance. That includes the overwhelming majority of those with incomes too high to qualify for state subsidies. Fewer than 30,000 unsubsidized residents have signed up as a result of the mandate. And that is on top of the 60,000 of the state’s uninsured who were exempted from the mandate because buying insurance would be too much of a financial burden.
Therefore, before real financial hardship hit the Commonwealth, approximately 400,000 residents did not comply, out of those, 60,000 sought and received exceptions from paying the state, and a mere 30,000 had signed up for coverage.
The cost to the Commonwealth, according to the study for 2008 was 1.8 Billion dollars for a plan that failed in its primary objective. In addition, private insurance premiums rose to meet a demand that clearly did not exist, and private endurance carriers, specifically Blue Cross/Blue Shield has instituted 10 to 11% increases each year since the plan was imposed on the State.
It is suggested that one read the CATO Institute Study here at www.cato.org.
What should be questioned, by every Massachusetts resident who is bound by law to buy insurance, and given limited carriers from which to choose is: "why the Commonwealth does not open up the pool of available insurers in much the same way it did with auto insurance coverage"? When the Commonwealth allowed auto insurance carriers to sell their wares across State Lines, residents noticed an immediate and significant drop in premiums.
Additionally, should the Federal Mandate be found unconstitutional, again, and again, and again, up to the Supreme Court, then would not the Massachusetts Model, with its limited availability, opt out clauses and massive inefficiency, be eligible for a similar suit?
To those Legislators in Rhode Island, kudos, look to the Massachusetts Model, and one can find multiple reasons why the Federal Program is in trouble before it has had a chance to truly take on Massachusetts ineptitude. The fact of the matter, there are options on the table that would reduce the cost for those uninsured, allowing consumers to buy across state lines, and make their own choices as to their health care.
The Federal Plan does offer an opt-out, however, only to those corporations that cannot “afford” total coverage: 700 plus organizations that have been allowed to opt out of the Federal Mandate so far. Full list of employers opting out and exception options via the U.S. Dept. of Health and Human Services here at www.hss.gov
From Massachusetts to Pennsylvania Avenue, what we have is a colossal waste of time that has cost billions in hours and revenue and has accomplished nothing more than increased court cases, without effectively reforming the system, which, is still in need of reform.
No comments:
Post a Comment