Covering the Uncovered
While Washington drags its collective feet on health reform, the states are moving ahead
For Joe Rothfarb, 24, getting coverage for healthcare has been a real pain in the neck. Years of playing the drums in a rock band have damaged the nerves that run up his left arm into his shoulder and neck, causing numbness and tingling and a sharp pain in his hand. The high-deductible policy he bought after college didn't kick in to help with his search for a diagnosis. His next plan did cover the doctor visits and tests-but when he tried to renew it last year, the carrier canceled. "I think I had too many claims," he says. Today, after months of going naked, Rothfarb is set: For just $40 a month plus copayments of $5 or $10, he's got a soup-to-nuts plan that should cover everything from CT scans to specialists to prescription drugs and physical therapy.
Rothfarb, who moved last September from California to Cambridge, Mass., is benefiting from his new state's effort to do right by its residents: health insurance for all. With the number of uninsured in the country now at 45 million and heading higher, and no real progress toward reform being made at the federal level, Massachusetts and a growing number of other states are finding ways to step into the breach. More than a dozen have proposed or enacted expanded coverage for children; Illinois, for example, provides comprehensive health and dental benefits for all kids up to age 18, regardless of income. New Jersey now allows parents to keep their kids on their health plans until age 30, as long as they have no dependents of their own. And at least a dozen states, including California, Pennsylvania, Maine, and Vermont, are working toward covering all or nearly all of their citizens.
Coverage for all. Massachusetts's plan, which launched a big enrollment push last week, is bolder and broader than anything on the books so far: It mandates that just about everybody have health insurance and subsidizes the costs for low-income residents. Policymakers and consumer advocates are watching closely. Such pacesetting efforts are "critical to what happens to the momentum for national health reform," says Drew Altman, president and CEO of the Kaiser Family Foundation, a nonpartisan research and education organization in Menlo Park, Calif. "They send a message that the paralysis we've seen in Washington is not necessarily inevitable."
Rothfarb, who's working part time for a health club and a crisis line while he applies to grad school, signed up for his plan through a new state agency that links individuals and small businesses with private plans whose benefits and rates are OK'd by the state. Since his income is less than 300 percent of the federal poverty level ($30,630 for a single person or $61,950 for a family of four), he qualifies for a partial subsidy from the state. By July1, nearly all Massachusetts residents will be required to have health insurance or face a yearly financial penalty. This year, it's equal to their personal income tax exemption, or $219. Next year, it will be 50 percent of the price of the cheapest insurance policy available to them. Businesses that don't offer insurance face a penalty of up to $295 per worker.