Massachusetts: Your insurance is illegal!

October 13th, 2009 | by Brian Schwartz |

Here is yet another example of how mandatory insurance can make your insurance policy illegal. Writes Wendy Williams in the Wall Street Journal:

…Massachusetts requires every resident to have health insurance, and this year, without informing us directly, the state had changed the rules in a way that made our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we neither need nor want—or enrolled in a government-sponsored insurance plan—we would have to pay $1,000 each year to the state.

…

For the first two years of the mandate, our IBM health insurance was seen as acceptable in the eyes of the state. This year the rules changed. The state requires that health plans cap out-of-pocket expenses for individuals (not including monthly premiums) at $2,000 a year. Our plan’s cap is $2,500.

Ten years ago, we had excellent coverage through a more gold-plated plan. But we found that it was no longer worth paying the premiums and scaled back to a more modest policy. Today, we pay about $300 a month for catastrophic care. If we went with the next step up in plans offered to us by IBM, our monthly premium would increase to $800. We simply don’t need to pay that kind of money for the amount of health care we actually consume.

Nonetheless, we now owe the state an extra $1,000. Ironically, that’s about the extra amount we would pay out-of-pocket under our current plan if both of us actually fell ill in the same year.

Read the whole article: Paying the Health Tax in Massachusetts.  See also the WSJ’s Guide to ObamCare.

(via FIRM)

tags: , ,
  • Quentin Ledford
    Recently while in public, I was as a benefits administrator and consultant, responding to one of my clients (a recent immigrant to Tennessee) who inquired my thoughts as to how reform was going to affect the health insurance industry.
    A passerby (I suspect was also probably not from here judging from her dialect) could not contain herself and felt that she needed to blast me (really the insurance industry) for her bitter experience. I thought I might relate this here as many folks may not have had the 'privilege' of experiencing a government run Obamalike healthcare plan firsthand as we have here in Tennessee.
    Here is what I was explaining to my client...

    1. Insurance mostly serves as a flow through mechanism, it does not drive the price of healthcare, it merely reacts to it.

    2. Insurance companies ARE heavily regulated and cannot be any more abusive than is permitted by law. In observing the legislation that has been passed over the last 25 years, it is impossible for any logical, reasonable person to conclude that the welfare of the American people is, or has ever, been considered in this arena.

    Too often, the legislation that has been passed over the years has not in any way been designed to either to protect the interest of the consumer, or facilitate the operating efficiency of those insurance carriers that are striving to provide quality protection and service to the consumer.

    I've watched the legislators on both Federal and State levels have passed volumes of laws for our 'benefit'. However, the truth of the matter is that most of the laws passed served the legal industry more than ANY other segment of our society. These laws, by and large, were drafted have been cobbled together by sycophantic politicians (most of whom are lawyers) catering to special interests, lobbyists, and their respective party affiliations.

    Here is the gist of what this very emotional passerby had to say on overhearing this brief conversation...
    "Unless you've been in my shoes, paying co-pays through the nose in order to keep cancer from killing you, don't try to tell me that insurance companies are going to take care of us...."

    After I calmed her down, she did let me explain the following....

    I could literally go on for hours about the inequities and abuses that do exists in our current system. However, a competent benefits professional should always be engaged to help folks avoid the pitfalls and obstacles to prevent situations such as yours. It is sad that, too often, many of the persons that are supposed to be 'experts' being entrusted to help protect folks have neither the experience, nor the expertise (and sometimes even lack the proper ethics) to effectively do this job. In employer situations I have found that many times the broker either is not dedicated to the field of benefits, or worse yet, is a relative of the responsible party and is wholly and totally unqualified to do the job. As a result, many people suffer.

    That said, here in Tennessee, the State experimented with what is now the ObamaCare model. It was called TennCare. I fought for claims and coverage with both the State and the private sector.

    This is what happened here...

    1. GETTING COVERAGE...
    - Too often, the people that really deserved and needed coverage, were DENIED this by the State program. These were folks that couldn't qualify for private coverage because, like you, they had major ongoing health issues, or adverse health history.
    - In addition, what really burned me was that, because of their personal or political affiliations/connections, many folks that were INSURABLE and well able to AFFORD purchasing coverage, were given TennCare for 'FREE'.
    - The TennCare system actually did try to operate itself like an insurance company, how?... By denying coverage and/or services to those persons deemed to be liabilities while extending coverage to those persons perceived to pose little risk.

    2. CLAIMS and SERVICES...
    Again, under TennCare, I often had to intervene on the behalf of individuals that experience delay and/or denial of coverage since the 'government' couldn't get its act together. These were urgent situations whereby the delay in care caused a deterioration in the condition of the patients.

    3. EFFECT on INSURANCE COMPETITION...
    TennCare willingly accepted the healthy individuals, but tried to avoid those with problems. This was devastating to the employer based programs. Many workers healthy workers signed on for 'free' TennCare leaving the less healthy workers (many of whom TennCare denied) forced to keep their private coverage. So the insurance companies ended up with a situation whereby they had no choice but to raise rates to nosebleed levels. Many insurance carriers quit doing business in Tennessee within three years after Tenncare was implemented. Prior to Tenncare, there were at least a dozen players in the game in Tennessee. Today, there are only two or three carriers even trying to compete and one carrier has about 90% market share.

    As I said earlier, I'm no great fan of insurance companies. There are some firms that are real scum as far as I am concerned. However, having assisted hundreds of individuals over the years in obtaining medical care and getting these services paid for on BOTH a governmental and a private level, I can say this...

    I would far rather have a (good) contract to defend someone with than have to fight governmental bureaucracy and politics.

    Furthermore, I've learned that regardless of what politicians say, they are far more corruptible and inherently have a far greater propensity for conflicts of interest than does ANY industry. Even worse, politicians bear little, if any, real accountability. Except in cases of outright embezzlement, it is seldom that politicians ever find themselves in court defending THEIR actions, no matter how reprehensible or self serving their actions or their course of conduct is proven to be. Amazingly, most unscrupulous legislators actually continue to get re-elected.

    Bear in mind too, while one can sue an insurance company and insurance brokers for damages, it is a nearly impossible to sue either the government or its agencies for damages.

    *****
    I'm not sure whether I had any impact on this lady's opinion; but it does help to illustrate some of the personal adverse experiences that the current administration is exploiting to accomplish their agenda.
    Obamacare, like Tenncare, is purportedly based on the noble premise of providing everyone with healthcare. However, the reality is that many people here in Tennessee are even aware that Tenncare was actually established through the collusion of two Tennessee governors, McWherter and Sunquist, whose motives were the far more sinister. Namely, to create a mechanism that would compel the citizenry of Tennessee to accept a State income tax by legislative force. So too, is this the case with Obamacare. The ONLY reason this agenda is being promulgated is to enable Congress further access to our income and assets. The only thing that stopped the legislators in their tracks was the mob force of the Tennessee citizenry literally ready to lynch them on the doorstep of the Statehouse.
    Two things are certain…
    1. We shall see NO improvement unless the American public wakes up and fires EVERY attorney in the legislative and executive branches of government regardless of political affiliation.
    2. If this madness is permitted to come to fruition; the government program will manifest all the operational finesse and efficiency of the Katrina relief program.
blog comments powered by Disqus