We asked Gov. Mitt Romney's policy staff to respond to the scenarios below. How would his plan help these people?

Scenario No. 1:

Wayne and Linda own a small breakfast place in Natick, Mass. They make between $25,000 and $29,000 a year for a family of two -- barely enough to cover their business and living expenses. They cannot afford health insurance. Linda recently had heart trouble and they're now faced with thousands of dollars in bills. They fear they will never "catch up" enough to even think about buying health insurance.

RESPONSE:

Wayne and Linda epitomize the group the governor is targeting with Safety Net Care. Two hundred percent of FPL (federal poverty level), $25,660, is the upper limit for MassHealth and the Insurance Partnership. The cut off is a cliff, meaning that if Wayne and Linda were to earn $1 less than the cut off, they might qualify for coverage. Once they exceed the income threshold by $1, they do not qualify for anything

As part of his negotiations with the U.S. Department of Health and Human Services to preserve $600 million of federal funding, the governor is proposing an insurance-like program for people like Wayne and Linda that are sandwiched between government entitlement programs and private insurance. Safety Net Care would be private insurance that would give Wayne and Linda healthcare coverage. The coverage may have limited networks, some cost sharing and some benefits limits, but it will be comprehensive healthcare. Premiums would be subsidized, but Wayne and Linda would have to make monthly payments. As they earn more money, the subsidy would gradually reduce until they reach 300 percent FPL, when we would expect them to transition to our affordable insurance product. Based on a Division of Healthcare Policy and Finance insurance census, it is believed that there are approximately 150,000 people in the commonwealth that are in a situation similar to that of Wayne and Linda.

SCENARIO No. 2:

Ernie is disabled and his wife Veronica works full-time as a parking attendant. When Ernie's SSI went up slightly, they were cut from Mass Health. Their children are still covered, but they are not. Veronica fears for Ernie's well-being, as he needs regular doctor visits.

RESPONSE:

Ernie, like many residents of the commonwealth, finds the Web of programs and eligibilities are difficult to navigate. In fact, Ernie likely qualifies for two programs. The first is called MassHealth Commonwealth, a program designed for the disabled. If Ernie is receiving SSI, then he qualifies. Depending on their family income, there may be a small monthly premium.

The second MassHealth option available to Ernie would be a "wrap-around" program that might make sense if Veronica's employer offers family insurance. If Veronica's employer offers private family coverage, then MassHealth Commonwealth, Premium Assistance would allow Ernie and Veronica to buy private, subsidized insurance through her employer, with MassHealth providing certain disabled wrap-around coverage.

Because of Ernie's change in income he probably transitioned from MassHealth standard to MassHealth Commonwealth without realizing it. Understanding the myriad of programs and eligibilities is difficult. HHS is in the process of rolling out the Electronic Virtual Gateway, an on-line tool that helps hospitals, physicians, caseworkers and private individuals access MassHealth programs. At the governor's direction, MassHealth has enrolled more than 40,000 individuals in the last 18 months who were eligible for programs but did not realize it. We refer to this group as the eligible, but un-enrolled. Based on the Division of Healthcare Policy and Finance, it is believed that there are approximately 100,000 eligible, but unenrolled individuals in the Commonwealth.

Scenario No. 3:

Colleen is 42 and single. She works 20-40 hours per week as a receptionist for an internet company and 24 hours plus hours a week as a computer specialist at a hospital. Her job offers no benefits. She can't afford the $500-800 per month to get insurance on her own.

RESPONSE:

Commonwealth Care, the affordable insurance product being proposed by Romney, addresses two issues faced by Colleen. The first is the high price of coverage. Commonwealth Care will offer a comprehensive benefits plan, including preventive care, hospitalization, emergency, prescription drugs and surgical coverages. The plan will have co-pays, reasonable deductibles and some network restrictions, but the benefits will be comprehensive and the monthly price will be about $200 per month vs. today's average of $354 in the small group and non-group market.

The second problem faced by Colleen is that because she has more than one job but does not work full-time at either employer, she is not offered benefits. Part of the Commonwealth Care program will be the creation of a new entity that will facilitate coverage for people working for multiple employers. Today, an employer cannot pro-rate coverage or contributions to reflect the amount of time worked. The new state entity will allow Colleen to pay her premium with pre-tax dollars, a 20 percent to 30 percent discount from today depending on her tax rate. In addition, employers will be able to make pro-rated payments. For example, if each employer wanted to contribute $50 per month, the state entity would serve as an aggregator for those contributions. In this scenario, Colleen would be receiving 50 percent subsidy from her employers and would be paying premiums with pre-tax dollars, even though neither employer is actually offering coverage.

Scenario No. 4:

Jim has worked for 22 years with full benefits, but then he was laid off. He now works for a small construction company, which does not offer benefits. His COBRA benefits from his previous job have just run out. Jim had a heart attack recently and needs hundreds of dollars in medication each month, which he cannot afford.

RESPONSE: Jim will be a prime candidate for Commonwealth Care, which is designed for sale to the individual. The coverage will include prescription drugs. Because Jim's COBRA just ended, he will be able to prove credible coverage and will not be subject to pre-existing condition/wait periods.

Even though Jim is a contractor, his employer would have the option to offer a defined contribution to his health plan through the "aggregator" set up under Commonwealth Care. As long has Jim continues to earn a paycheck, he will also be able to use pre-tax dollars to pay his premiums.

Because Commonwealth Care is sold to the individual, Jim will not have to buy a new plan every time he changes jobs. He will be able to develop a stable, on-going relationship with his primary care physician.