Sunday, August 30, 2009

10 Things You Need to Know About Health Care Reform

Paula, who gave us the Western Mass. story, has returned to tell us what happened to her beloved state once it adopted universal health coverage.

My husband and I live in a state that already has health care reform. We live in Massachusetts.

On April 12, 2006, our state legislature enacted a law requiring all residents to have health insurance.

They could buy it themselves, they could buy it from their employer through a group plan or, if their income was below a certain level, they could buy it from the state at a reduced rate. This is the so-called public plan. If people are totally disabled and therefore unemployable, and have no assets to cover the costs, the state pays for it. Very few people fit the last category.

Employers – even small-business owners – are required to provide basic minimum health care plans. If they do not, they are fined (a whopping) $295 per employee, per year.

To date, the vast majority of employers – even small-business owners – have found a way to provide health insurance plans for their employees. Few have paid the fines. In fact, the number of small-business employers in the state that do offer insurance rose from 88% to 92% from 2007 to 2008, according to a recent story in Investors Business Daily.

This program has been in effect almost three years. As far as we can tell, the world has not come to an end.

When the law was enacted, my husband was already enrolled in Medicare and I was buying my own individual policy (a high-level HMO) from a business association group I joined specifically to buy insurance at a discount. The last year I had it, I paid $620/month, plus $175/year for association membership dues.

Today, we’re both on Medicare, but buy a mid-level Medicare supplement HMO plan from Blue Cross/Blue Shield of Massachusetts. The supplement includes a drug plan and costs $119 a month, brining our total outlay for health insurance to $216 a month/per person.

Thanks to Medicare and the supplement plan, we’re saving about $800 per month for the two of us. Thank you, US taxpayers and government bureaucrats.

We weren’t sure we liked the idea of mandatory universal health care when it was first presented to the people of Massachusetts. We worried about reduced care, higher bills, and all the other things you worry about when you’re facing change.

Here’s what has happened to us as a result of mandatory, universal health care:

1. We still go to the same doctors.

2. We’re still on the same medications.

3. We still use the same pharmacy.

4. All other medical facilities we use – imaging labs, hospitals, blood testing labs, physical therapy -- have not changed.

5. As far as we can tell, our insurance premiums have not changed or have changed slightly ($5, maybe, per month).

6. Our co-pays are lower, but we’re on Medicare.

7. If I had stayed in the same HMO plan I had before Medicare, some of my co-pays would have increased for things such as substance abuse treatment and prosthetic limb fittings, not that I used any of those benefits.

8. I have greatly reduced my drug regimen and we both have increased our weekly exercise, in part, because our insurance now encourages prevention by paying a nice benefit for going to the gym.

9. We feel more comfortable being in crowds at the grocery store, movie theaters, or in close quarters at the barber shop and hair salon, knowing everyone there has access to health care. That means everyone we deal with is less likely to be spreading infectious disease than they were three years ago.

10. We’ll feel even better when this year’s flu season comes around, since school children, teachers, bank tellers, store clerks and others dealing with the public can get the necessary vaccines or treatment to contain this year’s flu, no matter how rich or poor they may be.

And that’s the truth.

This post originally appeared on Paula's blog, Birds on a Wire. Check it out.

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