Sunday’s A-1 Globe lead, Firms cancel health coverage, is another example that leaves us wondering if anecdote equals trend. Do we refudiate the story? Or acknowledge that public coverage can be the more appropriate choice for low-income workers?
The story reports that one broker claims that 90 small companies ended their insurance coverage with him, and that a “survey” (no details) finds that the workers are on public coverage. A consultant (presumably looking for business) is said to have enrolled 400 people in public coverage since April. Yet the Connector’s enrollment figures (pdf) show a slight decrease in net CommCare enrollment in April, with a 3,336 or 2.1% increase during May. The Connector attributed the increase to a batch of auto-enrolled members.
We don’t know if the reports indicate a change in employer behavior. The last comprehensive state survey of employers remarkably found an increase in employer offer rates. The study found that “the most significant growth in rates of offer were among employers with between 11 and 50 employees (where offer rates jumped from 88% in 2007 to 92% in 2009).” That survey was fielded during fall 2009, so it may not reflect what’s happening now.
The Massachusetts reforms are built on employer coverage. If we are to keep health reform successful, we suggest policymakers consider the following:
1. Premium Growth Control: The unchecked rise in small group premiums is the driver of employer behavior. Governor Patrick and the Division of Insurance has started to bring more accountability and public oversight to the process, but much more can be done to reasonably control premium growth. The House is expected to consider legislation on Wednesday to control small group and individual premiums. Their bill should be quickly reconciled with the Senate President’s bill so that the stronger regulatory enforcement can be put in place to reform our unstable market. These short-term measures must be followed up with comprehensive payment reform early next year, to being the path to sustainable health care focused on patient-centered prevention, wellness and health.
2. Crowd Out Rules: We have mixed feelings about the statutory crowd-out rules, that lock workers out of Commonwealth Care if they had access to employer coverage from their current employer in the past 6 months. After some horrendous early frustrations with how the Connector sought information to enforce the rule, the system appears to work well now. We don’t understand how a consultant can evade these rules, if this is what is happening. No one wants to penalize an innocent worker for the actions of an employer. If there’s an issue with the crowd-out provisions, stakeholders should be involved in understanding the dynamics and finding solutions.
3. Fair Share: We continue to advocate for strengthening the fair share provisions to more closely level the playing field between firms that provide coverage, and those that evade their responsibility. When firms drop coverage and their workers go on public-financed health care, we think those employers ought to pay a portion of the cost of coverage. Last year, the state paid over $800 million to cover workers from large companies, yet the Fair Share assessment brought in only around $7 million in revenue. At least until the federal free rider surcharge takes effect in 2014, this should be refudiated.