The Healthcare Committee of Vest Pocket is dedicated to improving the health of all members. One of the ways to do this is to help us get educated about the complexities of the problems in the healthcare system and possible solutions.

Information should go both ways. We'll post articles and links here and you, the members, can ask us questions and offer solutions. We are open to using Vest Pocket clout to change the healthcare system so it works for the businesses in our coalition with the final result being our good health. That takes all of us.

The state of Utah is looking very closely at the healthcare coverage plan that Massachusetts initiated on July 1, 2007. Their legislature was tasked with getting everyone in the state healthcare coverage.

The issue of affordability was of primary concern from day one. The architects of the Massachusetts program decided to start by tackling the problem of the affordability of private insurance plans.

An assessment of the Massachusetts plan from the Center for Studying Health System Change, a highly credible source of unbiased information can be found at: http://www.hschange.org/CONTENT/939/

A summary of what the assessment said follows:

Center for Studying Health System Change July 2007 Massachusetts Health Reform: Employers, Lower-Wage Workers and Universal Coverage By Laurie E. Felland, Debra A. Draper, Allison Liebhaber

In rapid fashion, Massachusetts has made efforts to both ignite demand for health insurance and establish a marketplace for individuals and small employers to purchase coverage.

Perhaps the most fundamental challenge is the issue of affordability. While most market observers agree that the primary goal of the reform is to improve access to health insurance, they contend that its ultimate success depends on affordability-both in the short term, as well as the long term. If affordable coverage is not available, it is unlikely that small employers on the cusp of offering insurance to their workers will be motivated to do so.

Affordability is also a concern of individuals and, despite the individual mandate to have health insurance, there are likely to be some people who will forgo coverage and pay the tax penalty. They may decide this based on individual assessments that they cannot afford coverage, which for lower-income individuals, in particular, may mean that basic needs such as housing and food take precedence over obtaining health insurance. Efforts in other states to reduce the number of uninsured by creating purchasing pools, offering insurance subsidies to employers and employees, tax credits or limited benefits often have struggled for precisely this reason-individuals' perceptions that they cannot afford coverage or that what they are buying is not worth the cost. In April, the Massachusetts Connector board reported plans to exempt nearly 20 percent of uninsured adults (approximately 60,000 people) who were ineligible for state subsidies from the individual mandate after determining that even the lowest cost insurance is unaffordable for them. The Connector board currently is revisiting the premium levels that will be considered affordable for people at all income levels, after learning that its proposed schedule would exempt significantly more people from the individual mandate than originally intended.

The challenge of affordability extends to a policy debate about what should be the balance between the financial obligations of individuals and the state. The less affordable coverage is for consumers, the more likely the state will have to commit additional monies to subsidize people to achieve near universal coverage.

There is also the issue of whether the Connector adds additional administrative costs to the system. Evidence from other states' purchasing pool initiatives suggest that the administrative costs of marketing, enrollment processing and premium collection, for example, can be significant.

What happens, however, if people forgo health insurance coverage, but still receive care?

The reform is being implemented during a time when the state's economy is strong and unemployment is low. What happens if there is an economic downturn?

The issue for Massachusetts may come down to how close to the goal of universal coverage is realistically attainable. Massachusetts has a lower percentage of uninsured people compared to most other states (N.B. Utah has a larger number of uninsured people than the average of the U.S.), which increases the feasibility of achieving near universal coverage. But at what point do the costs to the state getting one additional individual insured outweigh the benefits?