Insurance Is Not The Same as Healthcare Access

A little canary is tweeting in the coal mine of Massachusetts. Despite the availability of supposedly affordable insurance in that state, increasing numbers of its insured citizens are calling patient-assistance hotlines. They say they are having trouble paying their medical bills and are not getting the care they need. That should be of great interest to Congressional committees that are modeling national reform after Massachusetts’ program.

Massachusetts is funding its near-universal coverage partly with federal funds. The federal government, which has only the taxpayers to fall back upon, is considering various tax increases to pay for coverage expansion. The alternatives range from a tax on the value of employer-paid insurance to a federal sales tax to taxes on soft drinks and other comestibles said to be threats to public health. A New York Times poll has found that many consumers would be willing to pay higher taxes to ensure that everyone was covered. But I wonder how many of them would feel about being taxed on their company health benefits at the same time that they had to pay rising premiums, copayments and deductibles. Especially if they had health problems, they might be quite angry.

The story about Massachusetts’ debt-ridden patients also made me think about the individual insurance mandate that Congress is discussing. The House committees that recently floated a draft of their reform package would subsidize insurance for consumers with incomes up to 400 percent of the federal poverty level—$88,200 for a family of four. Even at that level–and there are discussions about reducing it to save money–most people would not be able to buy decent coverage on their own in the individual market.

So where does that leave them if Congress adopts legislation requiring them to buy insurance, even if their employer doesn’t offer it? Perhaps they could get lower-cost insurance through a government-sponsored insurance exchange modeled after the Massachusetts Connector and the Federal Employee Health Benefit Program. Perhaps a public plan would cost less than private insurance if it had the clout of the federal government behind it. But most likely, they will be forced to buy a skimpy health plan. And if they get sick, they’ll be unable to pay their bills and will be calling a federal patient-assistance line.

Congressional reformers should bear in mind that insurance coverage is not the same as access to health care. If they focused more on the latter, and on what’s really driving up costs, they would be more likely to find a fair and effective way to cover everyone, without raising taxes.