'Affordable' health care

I haven't been to a doctor in over 10 years," Mike Kochis boasted from behind the counter of Ashley's Ice Cream, a favorite New Haven, Conn., late-night hang-out spot for Yale students. Wearing a weathered "Life is good" hat, the 30-year-old described himself as a "super-super college senior" and readily stated that he has not purchased any health insurance. Though Ashley's offers a policy through the company that would pay half of Mr. Kochis' insurance costs, he said the cost is still too high, and assumes that he will not have a medical emergency.

If Mr. Kochis lived in Massachusetts, he would be one of the people whose situation Gov. Mitt Romney's new universal health insurance plan, passed last month, would seek to remedy. Mr. Romney asserts that 40 percent of Massachusetts residents are like Mr. Kochis: not poor enough to qualify for Medicaid, not rich enough to afford their own private insurance. Floating in a health insurance vacuum, they are unlikely to obtain preventative care and often end up needing expensive emergency care. By federal law, hospitals cannot deny anyone life-saving treatment due to inability to pay, so hospitals and taxpayers bleed out the money.

Mr. Romney's solution for the problem of such "free riders" is to make health insurance cheaper through subsidies and tax breaks, and then to require everyone to get it. The new law, though, specifies that individuals must buy insurance provided that it is "affordable." Though the law has been passed, it is still up to the Massachusetts Division of Insurance to determine the guidelines for affordability of packages offered by insurance companies, and then for those insurance companies to agree to offer these "affordable" rates.

"It's a whole new universe that we're exploring," Christopher Goetcheus of the Massachusetts Division of Insurance told WORLD. "It was tough to get the law passed, but it will be even tougher to come up with affordable insurance."

Insurance for a single 25-year-old who lives in the Boston area and purchases an Anthem Blue Cross Blue Shield plan with a $250 deductible costs $608 per month; one who lives in the Springfield area of western Massachusetts pays $536 per month.

In nearby Connecticut, the most comprehensive Anthem Blue Cross Blue Shield plan costs only $283 per month, less than half of the average cost of comparable Massachusetts insurance. Mr. Goetcheus explained the difference by noting that "Massachusetts has the Cadillac of benefits": a blizzard of lobbyist activity has influenced the legislature to pass what are known as "mandated benefits" that include coverage for chiropractic care, infertility treatments, and much more: Massachusetts even has special provisions for people with PKU, a rare genetic disease. The Massachusetts insurance website includes 42 new press releases listing different mandates added to insurance coverage since the late 1990s. These mandates fiercely drive up costs individuals must pay.

Asked whether these highly specific mandated benefits are worth driving up the cost for everyone, Mr. Goetcheus replied, "The legislature makes the playbook. We just use it. Every single mandated benefit must have helped someone along the line, but the bottom line is, they make plans very unaffordable."

If Mr. Romney's plan has overlooked the main reason that insurance premiums are unaffordable in his state, it still leaves Connecticut with the problem of ice-cream-scooper Mike. In Connecticut, insurance is almost half the price charged in Massachusetts, yet many residents remain uninsured, even though a policy that insures purchasers against medical catastrophe can cost as little as $30 per month. Mr. Kochis works at least 45 hours per week and earns over $10 per hour, but says he cannot afford health insurance.

The option of a catastrophic-insurance-only policy receives little publicity and is unsatisfactory to many since it doesn't cover screenings, physicals, prescriptions, or any preventive care. Still, it is "affordable" for Mr. Kochis and many others. That means the Massachusetts law's caveat that insurance must be "affordable" is looking problematic.

-Victoria Holowink is a junior at Yale