New England States Struggle To Find The Right Formula
By HILARY WALDMAN • Courant Staff Writer
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.
Massachusetts
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
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
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."
Contact Hilary Waldman at hwaldman@courant.com.
Copyright 2007, Hartford Courant
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