The number one reason millions of American lack health insurance is they cannot afford it. In Massachusetts, our health reform law has enabled hundreds of thousands of previously uninsured residents to get affordable, quality health coverage. However, sliding scale subsidies for insurance only reach individuals and families up to 300% of the federal poverty level (FPL), an income of about $32,000 for an individual.
The only option for most Massachusetts residents above 300% FPL, without access to employer sponsored insurance, is to buy insurance on the private market. Although our 2006 reform bill allowed individuals to get group rates (which cut individual premiums by up to 40%), many middle-income residents continue to find health insurance premiums unmanageable.
With national health reform, health insurance will be affordable for more middle class families in Massachusetts. Both the House and Senate bills, as well as President Obama's proposal, provide subsidies for people who make up to 400% FPL, or about $43,000 for an individual and $88,000 for a family of four. About 75,000 additional Massachusetts residents will receive subsidies to help pay health care insurance premiums.
Every year in Massachusetts, the Connector develops an Affordability Schedule that determines the maximum premiums that Massachusetts residents are considered able to afford for health insurance. Currently, the Schedule only takes the cost of premiums into account. We all know that insurance premiums are not the only health care costs people face; many insurance plans require subscribers to pay co-pays, deductibles, and/or co-insurance.
The federal bills take into consideration all out-of-pocket costs, not just premiums, in the definition of affordability. Unaffordable out-of-pocket costs pose a barrier to care for people who have insurance. Capping out-of-pocket costs helps protect individuals and families from medical debt and removes obstacles to getting needed care.
National health reform would build on the success of Massachusetts health reform, and provide more Bay Staters with affordable coverage. National health reform is good for Massachusetts. We ask Congress to pass national health reform legislation now. Please call or send an email to your Representative in Washington. For assistance and information to make it easy, click here.