Polemic Assignment progress continued

I. Rebuttal, Concession, Redirection

a. Cost

i. Concede the fact that costs will rise

ii. Increased cigarette tax

b. Compliance

i. Cigarette tax curbing cost à Won’t have to force people to pay more

ii. Compliance will remain the same

c. Limited market

i. Benefits of The Connector

ii. No authority to regulate insurance

Rebuttal, Concession, and Redirection

Cost and Compliance

It is true that health care costs will continue to rise but Massachusetts lawmakers have already devised a plan to solve this problem. To help pay for the larger-than-expected enrollment in the law’s subsidized insurance plans, lawmakers have decided to raise the state’s cigarette tax by a dollar. Steve LeBlanc, Associated Press Writer for the Boston Globe writes, “Lawmakers are hoping to close the gap in part with a new cigarette tax expected to generate about $154 million a year.”8 With the cigarette tax curbing the rising cost of health care, the state will not have to force people to pay more for their health insurance. Therefore, non-compliance will not be an issue due to cost. If costs remain the same or decrease, then compliance will most likely remain the same as it is now or even increase.

Limited Market

It is true that the Connector has a limited selection of insurance options but the benefits of the Connector outweigh the detriments tremendously. The Heritage Foundation, an advocate of the Massachusetts health law states, “Markets sometimes work more efficiently and effectively when there is a single place to facilitate diverse economic activity.”7 The Heritage Foundation also compares the Connector to the Federal Employee Health Benefit Program, which both exemplify the basic features of managed competition.7 With the Connector, consumers are able to choose from a limited menu of insurance plans where subsidies are structured so that consumers choosing more expensive plans have to bear the portion of the cost.7 Also, contrary to belief, the Connector has no authority to regulate insurance. Defenders of the Massachusetts law say that the Connector “must offer for sale any and all products that have been approved for sale by the state’s Division of Insurance.”7 Therefore, the Connector solely aids as a middleman to help citizens find affordable coverage. Through the Connector, thousands of Massachusetts citizens have become insured since the law was implemented.

Polemic Assignment progress continued

I. Counter Arguments

a. Future problem – cost

i. Rising cost of health care

ii. Increasing the cost of insurance

b. Enforcement – compliance

i. Forcing people to pay more

ii. Stray from universal coverage

c. Limited market

i. The Connector

ii. Less choice

iii. Outside market will slowly diminish

Counter Arguments

Cost

One economic argument is that the Massachusetts Health Care Reform Law will be defeated by the rising cost of health care.[1] According to Jennifer Fisher Wilson, Science Reporter for Annals of Internal Medicine, “Financial pressures are a considerable concern, and the ability to keep costs down is crucial to the future of the reform effort.”[2] Health care costs are projected to rise considerably over the next few years. In a time of economic crisis, the Massachusetts health law may not survive. It was estimated in 2006 that the law would cost $725 million in the fiscal year starting in July.[3] Governor Deval Patrick set aside $869 million for the law, but those overseeing the law have already acknowledged costs will rise even higher.4 One example of the economic argument is Michael Tanner, Director of health and welfare studies at the Cato Institute, who argues that as more benefits are added to health insurance plans, the cost of the mandate will increase, placing legislators in a difficult position.[4] Legislators may be forced to put the burden on the citizens purchasing health insurance coverage.

Compliance

One legal argument is that if the state tells people they must pay more for their mandatory insurance, then there will be an increase in non-compliance with the mandate.2 One of the main goals of the Massachusetts health law was to make health insurance affordable to everyone. If the costs that citizens are required to pay for their health insurance increases, then many citizens will, again, be unable to afford it. Also, many of the citizens choose not to comply because it is less expensive to pay the fine and continue without insurance.5 For example, Michael Tanner, in his article “No Miracle in Massachusetts: Why Governor Romney’s Health Care Reform Won’t Work” writes that the law “has the perverse effect of creating penalties that are large enough to be onerous but still smaller than the cost of purchasing insurance.”5 If compliance begins to decrease, then the Massachusetts health law will no longer be seen as a successful model for other states.

Limited Market

One Republican argument is that the Massachusetts health law has a limited health insurance market and constrains the choices of citizens. The law set up an authority, known as the Commonwealth Health Insurance Connector, which sets subsidy levels, sets the affordability standards for the individual mandate, and decide what insurance plans can be offered through the Connector.[5] According to Tanner, “Anyone who receives any subsidy is limited to a choice among a more limited menu of insurance options that have low deductibles and limited cost sharing.”[6] Therefore, anyone who chooses or is forced to find health insurance through the Connector is subject to a limited choice of health insurance providers. There is small group or individual insurance available outside the Connector, but the subsidies and tax advantages are available only within the Connector.7 Opponents argue that “the Connector will become a monopsony purchaser of health insurance.”7

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[1] Crook, Clive. "The Massachusetts Experiment." National Journal 38.25 (24 June 2006): 18-19. Academic Search Premier. EBSCO. 18 Nov. 2008 .

[2] Wilson, Jennifer Fisher. "Massachusetts Health Care Reform Is a Pioneer Effort, but Complications Remain." Annals of Internal Medicine 148.6 (18 Mar. 2008): 489-W102. Academic Search Premier. EBSCO. 18 Nov. 2008 .

[3] LeBlanc, Steve. "At two-year mark, Mass. health care law still a work in progress." Boston.com. 11 Apr. 2008. The Boston Globe. 17 Nov. 2008 .

[4] Tanner, Michael D. "No Miracle in Massachusetts: Why Governor Romney's Health Care Reform Won't Work." 6 June 2006. CATO Institute. 16 Nov. 2008 .

[5] "MA HEALTH CARE REFORM LAW OF 2006." Affordable Care Today. 2007. 17 Nov. 2008 .

[6] Tanner, Michael D. "No Miracle in Massachusetts: Why Governor Romney's Health Care Reform Won't Work." 6 June 2006. CATO Institute. 16 Nov. 2008 .