Transcript for the Piece Audio version of Health Reform Part 2 - The Individual Mandate in Massachusetts

HEALTH REFORM #2 -- THE MANDATE
SINCE 2006, WHEN MASSACHUSETTS BECAME THE FIRST STATE TO REQUIRE ALL RESIDENTS TO HAVE HEALTH INSURANCE., ABOUT 250,000 MORE STATE RESIDENTS HAVE EITHER BOUGHT POLICIES OR ACCEPTED THEIR EMPLOYER'S PLAN. SOME LEADERS IN WASHINGTON WANT TO DO THE SAME THING NATIONWIDE. BUT AS WFCR’S KAREN BROWN REPORTS IN HER SERIES ON MASSACHUSETTS LANDMARK HEALTH CARE LAW, THE MANDATE REMAINS CONTROVERSIAL.

A SURVEY LAST YEAR BY HARVARD UNIVERSITY FOUND THAT ALMOST 60 PERCENT OF MASSACHUSETTS RESIDENTS APPROVE OF THE STATE’S INSURANCE MANDATE. GARY CLOUTIER IS NOT ONE OF THEM.
you're forcing something down my throat, then you're penalizing me because i can't afford it.

AMB: sounds of auto body shop....

CLOUTIER IS A STOCKY 47-YEAR-OLD WHO OWNS HIS OWN AUTO BODY REPAIR SHOP IN WESTFIELD. HE HELPS SUPPORT HIS FIANCE AND HER THREE CHILDREN ON ABOUT FORTY-THOUSAND DOLLARS A YEAR. BUT SINCE THE ECONOMY TOOK A PLUNGE, FEWER PEOPLE ARE GETTING THEIR FENDERS FIXED. CLOUTIER IS RELIEVED WHEN A RETURN CUSTOMER BRINGS IN HIS CAR.
we can get it in right away, bc unfortunately we're not very busy – oh, ok…. (fade under)

EVEN BEFORE THE DOWNTTURN, CLOUTIER HAD NO BUDGET FOR HEALTH INSURANCE – AND IT’S WORRIED HIM.

CLOUTIER:0:19:47.5 Given the toxic chemicals that i'm dealing w/ day in & day out in the line of my business, i'm probably a walking cancer time bomb right now. Who knows?

AFTER THE HEALTH LAW PASSED, CLOUTIER WAS HOPING TO FIND AN AFFORDABLE INSURANCE POLICY. THAT’S WHAT HE THOUGHT HEALTH REFORM WAS ALL ABOUT. BUT HIS SALARY WAS TOO HIGH FOR THE STATE-SUBSIDIZED PLAN, CALLED COMMONWEALTH CARE. HE LOOKED AT THE LIST OF PRIVATE PLANS BROKERED BY THE STATE; THE CHEAPEST WAS ABOUT 400 DOLLARS A MONTH -- MORE THAN HE FELT HE COULD AFFORD. HE FINALLY LOST HIS COOL WHEN HE HEARD THAT THE STANDARD PENALTY FOR PEOPLE WITHOUT HEALTH INSURANCE WOULD BE $900 THIS YEAR, AND 1100 NEXT YEAR.
0:36:51.2 GC: That doesn’t solve the problem. It just moves the problem someplace else.

CLOUTIER IS NOT LOOKING AT THE STATE’S TACTICS FROM A PUBLIC POLICY PERSPECTIVE. NEIL CRONIN WISHES HE WOULD.
CRONIN: the whole premise behind health reform has been that insurance becomes more affordable when everybody is in the system.
CRONIN IS WITH THE MASSACHUSETTS LAW REFORM INSTITUTE, WHICH ADVOCATES FOR LOW-INCOME CONSUMERS.
CRONIN: that if you leave an insurance system only to the sick & the elderly, then the costs of that care or that insurance rises dramatically for those people who are heavy utilizers. so the way to spread the risk is to get everybody on board.

DREYFUS: There's a social compact that's part of our health insurance law.

ANDREW DREYFUS IS A VICE PRESIDENT AT BLUE CROSS BLUE SHIELD OF MASSACHUSETTS – WHICH INSURES 3 MILLION PEOPLE, AND GAINED ABOUT 20,000 NEW CUSTOMERS SINCE THE LAW PASSED.
DREYFUS: when we first did the analysis of who was uninsured in MA, a lot of the uninsured were people who could afford coverage w/o a subsidy & when they got sick, got into a car accident, went to the ER we all paid for it. the whole system was subsidizing that group of people. & i think it makes sense to bring them in.

THE STATE DOES ACKNOWLEDGE THE PREDICAMENT OF MIDDLE-INCOME WORKERS LIKE GARY CLOUTIER – WHO MAKE TOO MUCH TO QUALIFY FOR A SUBSIDY BUT TOO LITTLE TO AFFORD INSURANCE. THEY CAN APPLY FOR A WAIVER FROM THE PENALTY, ALTHOUGH MANY PEOPLE, INCLUDING CLOUTIER, DIDN’T KNOW ABOUT THAT OPTION. OUT OF THE 200,000 PEOPLE STILL UNINSURED IN MASSACHUSETTS, MOST -- ACCORDING TO ONE STATE SURVEY -- ARE HEALTHY YOUNG PEOPLE -- EXACTLY THE DEMOGRAPHIC THE MANDATE WAS SUPPOSED TO BRING INTO THE SYSTEM.
LUCAS: 0:15:39.6 ... we're all arrogant & we all think nothings ever going to happen to us
LUCAS WYANT IS A HOUSEPAINTER – 27-YEARS-OLD AND PHYSICALLY FIT.
i just try not to do anything too dangerous in my life. you know, i actually think about not going downhill skiing & stuff.... [i test my luck once a year & hope i don't get hurt.?]
WYANT WORKS FOR A SMALL COMPANY IN NORTHAMPTON THAT DOESN'T OFFER HEALTH BENEFITS. FOR THE PAST FEW YEARS, HIS SALARY HAS BEEN IN THE MID-THIRTIES – A HAIR TOO HIGH TO QUALIFY FOR COMMONWEALTH CARE. HE COULD GET A SPECIAL POLICY DESIGNED FOR YOUNG PEOPLE AT JUST UNDER 200 DOLLARS A MONTH.
Which i could pay for but it would be a little bit hard for me to pay that much a month for something that i don't really use. .....
WYANT SAYS THE ONLY WAY HE’LL GET INSURANCE IS IF HE ENDS UP QUALIFYING FOR A STATE SUBSIDY. FOR 59-YEAR-OLD MICHAEL DELANEY, THE FINAL INCENTIVE TO BUY INSURANCE WAS THE THREAT OF A STATE PENALTY. DELANEY IS A SELF-EMPLOYED TITLE-EXAMINER IN EASTHAMPTON. FOR YEARS, HE PREFERRED TO PAY FOR THE OCCASIONAL DOCTOR'S VISIT THAN SHELL OUT FOR HEALTH INSURANCE. BUT NOW HE PAYS $400 A MONTH – ABOUT TEN PERCENT OF HIS INCOME – FOR A HIGH DEDUCTIBLE PLAN.
MD: what it means practically speaking is, i can't take a decent vacation. ... i can't save any money towards retirement, i can't prepay my mortgage. I'm pretty much breaking even right now.

DELANEY IS ONE OF 40,000 PEOPLE WHO BOUGHT PRIVATE COVERAGE TO COMPLY WITH THE STATE’S MANDATE. AND HE HAS USED IT. FOR YEARS, HE'S HAD A RECURRING CONDITION THAT LEAVES HIM FATIQUED FOR MONTHS. BEFORE HE HAD INSURANCE, THE DOCTORS WOULD DO SIMPLE BLOOD TESTS AND FIND NOTHING. BUT IN THE LAST YEAR, WITH INSURANCE CARD IN HARD, HE GOT A VERY DIFFERENT TREATMENT.
i wore a heart monitor around for a day, i had an MRI done, i went to Holyoke hospital for an overnight 0:06:13.0 sleep test to see if i have sleep apnea. ....0:06:38.7

IN THE END, HE SAYS, HE BURNED THROUGH HIS $2,000-DOLLAR DEDUCTIBLE, COST THE HEALTH CARE SYSTEM THOUSANDS MORE, AND THE DOCTORS STILL COULDN'T DIAGNOSE HIM. IT MADE HIM WONDER WHETHER ALL THE EFFORTS AROUND GETTING PEOPLE INSURED….ACTUALLY TRANSLATES INTO BETTER HEALTH CARE..
0:10:32.3 i still feel philosophically that the state should not be mandating a private health insurance policy. if they want to set up a state system such at the Canadians have or Europeans have that's fine. i don't object to paying taxes for that.

AND YET, DELANEY ADMITS THAT HIS INSURANCE PREMIUM HAS BOUGHT HIM PEACE OF MIND, AND A BIT OF PERSONAL FREEDOM. LAST WINTER, FOR THE FIRST TIME IN YEARS, HE WENT CROSS-COUNTRY SKIING. I'M KAREN BROWN.