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Drug-free health bids requested; Mass. insurance board to measure affordability.

Byline: John J. Monahan

BOSTON - The state board setting up minimum-coverage insurance plans before a July deadline - when all state residents must have health insurance - indicated yesterday that it may consider dropping prescription drug coverage to make those plans more affordable.

Several members of the Commonwealth Health Insurance Connector board questioned the quality of health care afforded by plans without drug coverage, and one labor representative on the board said she would oppose eliminating drug coverage from the plans.

But saying the responses would provide them more information, the board voted to ask companies bidding to offer minimum coverage plans to resubmit proposals showing the difference in monthly premium costs - with and without drug coverage.

The decision came as the board is under pressure to lower the monthly premiums offered by dozens of companies that have bid to offer minimum coverage plans. The plans will be marketed to those who do not meet the 300 percent poverty level income cutoff for state subsidized insurance coverage.

Proposals for minimum coverage plans that included drug coverage with copayments were submitted last month. They carried monthly premiums ranging from $250 for young individuals to more than $500 for those in their 50s, with an average cost of $380 per month. Those prices were viewed as far more expensive than the costs envisioned when the insurance mandate was adopted last year.

At that time House and Senate leaders said they expected health care plans, including prescription coverage, to cost less than $300 per month, and Gov. Mitt Romney suggested they should be made available at a price closer to $200 per month.

Since then, the connector authority has been scrambling to get insurers to recalculate plan offerings and lower the monthly premiums.

The connector authority's executive director, Jonathan M. Kingsdale, said yesterday the re-bidding process could produce significant price changes, noting that re-bidding proposals for subsidized coverage last year resulted in a 15 percent reduction in the costs, without eliminating drug coverage.

He said he is unsure how much elimination of drug coverage would lower the costs of the unsubsidized plans, although some experts have estimated it would lower premiums by about 15 percent.

"We need to do a second round of bids and see what the numbers come in at," Mr. Kingsdale said, adding that should be finished over the next two weeks.

The board is expected to make some final decisions March 8 to allow time for the plans to be marketed to the public starting May 1.

Board Chairwoman Leslie A. Kirwan, state secretary of Administration and Finance, said the governor has also been working to bring the coverage costs down as affordability is seen as a key factor in whether the first-in-the-nation mandatory health insurance program will succeed.

She said it may end up that a phased approach will have to be "carefully considered" that would add drug coverage to minimum coverage requirements in the future.

She said another problem with requiring drug coverage is that while the new plans are targeted to deliver affordable insurance to some 500,000 to 600,000 uninsured in the state, more than 160,000 insured individuals have plans that do not provide any drug coverage and another 42,000 have plans with partial drug coverage that would not meet the minimum coverage standard being planned by the board.

Ms. Kirwan said a mandatory drug coverage standard could result in those people dropping or losing insurance coverage they have because it would not meet the drug coverage requirement. She said that would be "a step backward" from the goal of universal insurance coverage.

"I would not favor saying their coverage is no longer good," Ms. Kirwan said.

But other board members bristled at the idea of not providing drug coverage in all health plans, a goal set out at the start of the program as essential for quality health care.

Board member Dolores Mitchell said during the board's discussion yesterday that serious medical ramifications will result if prescription coverage is dropped from the minimum coverage requirements.

"We would be ruling out (coverage) of about 20 percent of what people pay," for health care, she said. "We should get some advice on the medical implications of not covering drugs."

Board member Bruce W. Butler, a retired insurance executive, said drug coverage is critical for quality health care.

"We are going to drive people to one form of treatment or another," depending on whether people have coverage and can afford prescribed medicines, he said.

Celia A. Wcislo, a labor representative on the board, said she would not go along with dropping drug coverage in the plans.

"In my mind I am not reconsidering drug coverage," she said.
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Publication:Telegram & Gazette (Worcester, MA)
Date:Feb 9, 2007
Words:781
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