A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

A Reason to Appreciate the MA Market

A Reason to Appreciate the MA Market

May 5, 2007

Lots of compelling stuff in today's NYT -- check out this article on "Small Businesses’ Premiums Soar After Illness" by Milt Freudenheim. Small businesses find their health insurance premiums going up astronomically after just one worker has a serious illness -- and the higher rates stay in place years after the worker in question dies. Common practice in most parts of the nation. (And check out this companion article on the difficulties facing the self-employed -- click here.)

And then appreciate this -- Massachusetts is one of a small number of states where this can't happen in either the small business (1-50 workers) or individual markets because of protections put in place in 1991 (small group) and 1996 (nongroup). We have guaranteed issue, guaranteed renewal, a strick prohibition on medical underwriting (rating individuals or businesses based on health status), tight controls on pre-existing condition exclusions, modified community rating so the highest and lowest premiums can't vary by more than two to one, and -- beginning 7/1/07 -- a merged small and individual market.

And, yeah, we pay more in premiums because of these rules. Simple reason. It costs more to provide health coverage when insurers are required to cover you when you're sick. In most other states, get sick and get dumped as soon as your policy expires.

This isn't to suggest we couldn't do a lot better, because we surely could and we'll keep working to make it better. Worth realizing we could also do a lot, lot worse.