New England States Struggle To Find The Right Formula
Juan Martinez had not seen a doctor in the five years since he left Peru when he arrived one recent winter afternoon at the converted camper-turned-clinic operated by the Malta House of Care Foundation.
After waiting for a short while in the church basement that served this day as the mobile clinic’s waiting room, he was examined by Dr. William Harris, a retired family physician who volunteers his time.
He left with orders for blood tests that would be performed free at St. Francis Hospital and Medical Center, which underwrites the mobile clinic’s cost with help from private donors and the Archdiocese of Hartford. And if the tests show that Martinez needs medication, he’ll get that free, too.
Nobody asked for Martinez’s insurance card when he arrived and nobody asked for payment when he left.
This is true universal health care, provided by a charity and volunteers who park the decrepit camper in church parking lots three afternoons a week and care for Hartford’s poorest residents, many of whom are Latinos who speak no English and have no paperwork documenting legal entry into the United States.
And it’s a far cry from any so-called health care reform plan adopted or proposed by any state government – including Connecticut’s – so far.
Throughout the nation, state governments are looking at ways to provide health care to an estimated 46 million people who have no insurance.
With up to 400,000 Connecticut residents lacking insurance, the crisis has caught the attention of business leaders, the governor and lawmakers. So far, half a dozen proposals for expanding coverage have been floated at the Capitol.
On paper, at least, it looks as if Connecticut might have the luxury of following the examples of its neighbors. Massachusetts, Maine and Vermont have passed the nation’s most ambitious health care reform laws that claim to safeguard every resident from catastrophic medical expenses.
So far, each of those states has been successful in extending coverage to more of its lowest-income residents. But all are struggling to find a way to help working-poor and middle-income families to purchase insurance at an affordable price.
“What is affordable?” said John E. McDonough, executive director of Health Care for All of Massachusetts, an advocacy group. “The definition of affordable has not been created.”
As Connecticut tackles the problem of how to provide health care to every resident at a price that business, individuals and the government can swallow, here is a look at where the other states stand.
The plan’s cornerstone is a requirement that every person carry health insurance. The state will subsidize coverage for families with incomes up to 300 percent of federal poverty guidelines – about $62,000 for a family of four.
Families making more are on their own, but they would be able to buy insurance through a state authority called the Commonwealth Health Insurance Connector. Although the pool is still being phased in, early estimates of average monthly premiums range from $276 to $391.
Employers are encouraged to make insurance available to their employees, and they face a penalty of $295 per employee, per year, if they do not. The state will assume that employers offer a “fair and reasonable” plan if 25 percent of employees are enrolled in the company’s group health plan and if the employer contributes toward the premium.
So far, about 100,000 of the state’s lowest-income residents have picked up health insurance under the program, but up to 400,000 people continue to have no insurance.
Vermont also adopted a comprehensive health insurance reform plan in 2006. It also provides subsidies to help people earning up to 300 percent of the federal poverty guidelines to pay for health insurance. In addition to offering state-sponsored insurance, Vermont has agreed to help low-income workers buy employer-sponsored group plans.
As in Massachusetts, the cost of health insurance for people who are not destitute has yet to be determined.
Employers who do not pay part of the cost of their workers’ insurance would be subject to a penalty of $365 per employee, per year. There is no requirement that individuals buy health insurance.
Beyond making health insurance available to more people, Vermont’s plan aims to cut health care costs by reducing the need for expensive care. It is estimated that 70 percent of all health care costs are from chronic diseases. Vermont’s plan includes a “blueprint” for managing conditions such as diabetes, high blood pressure, heart disease, cancer, asthma, lung disease, substance abuse, spinal cord injury and obesity to prevent some of their expensive complications.
Maine was the first state to attempt comprehensive health insurance reform. The centerpiece of its plan is a state-sponsored insurance pool open to small businesses, the self-employed and individuals without access to employer-sponsored insurance. The program offers discounts on monthly premiums, deductibles and out-of-pocket expenses on a sliding scale for people who earn below 300 percent of federal poverty guidelines.
But like in the other states that are trying to promote universal coverage, Maine so far has succeeded only in extending health insurance to the poorest of the poor. The state set a goal of expanding coverage to all uninsured Maine residents by 2009, but so far, it had enrolled only 12,000 people.
The Maine program also has been hampered by lawsuits. Last year, the governor appointed a blue ribbon commission to try to iron out kinks in the system.
Juan Figueroa, president of the Universal Health Care Foundation of Connecticut, said that the frustrations experienced by neighboring states illustrate how difficult reforming health care here will be.
He said that he feels a groundswell of support for universal health care coverage in Connecticut. But like everything else, the devil will be in the details.
“It’s hard because you’re trying to legislate a real minefield of potential economic and political agendas,” Figueroa said. “It’s been an issue from Roosevelt to the Clintons, and so far we have not been able to overcome those political and financial interests.”
By HILARY WALDMAN • Courant Staff Writer
Copyright 2007, Hartford Courant