BOSTON -- For the past couple of weeks, WCVB has been profiling some of the state's uninsured residents, in particular some of the 350,000 Bay State residents who have a job but do not have health benefits. This week, we take a look at the proposed solutions.
NewsCenter 5's medical editor Dr. Timothy Johnson reported that several states have already implemented -- with mixed results -- Medicaid-type programs for those who work.
Minnesota is rated the healthiest state in the nation and also has the lowest number of uninsured. In 1992, the state adopted Minnesota Cares, a Medicaid-type program for those who work but don't have health insurance.
The cost of Minnesota Cares is based on an individual's income with the average premium just $22 per month. Then there are co-pays for each doctor visit.
"There is one category that is out of whack and it is this program of health care welfare spending," said Minnesota Gov. Tim Pawlenty.
The problem in Minnesota is that the plan is so good that four out of five citizens who were eligible signed up for the plan. The plan is now on the verge of bankruptcy, and politicians want to cut back.
New York has also experimented with a similar program with mixed success. Healthy New York was adopted in 2001 and is geared toward small-business owners and their workers.
The New York program works like this: The state assumes payment of about 5 percent of medical cases -- the most expensive and complicated ones. That allows insurers to lower premiums for everyone else. Last year, premiums decreased 17 percent to about $150 to $200 per person.
But the New York program is running into problems, too. After four years, just 76,000 people have enrolled, and the cost of the program is increasing faster than the money to fund it.
Maine residents who qualify have the option to enroll in Dirigo Choice. The program is run by Blue Cross and is an option for small businesses and their employees who work at least 20 hours a week.
Dirigo Choice covers 100 percent of physicals and well visits. For sick visits, there are some co-pays, and a deductible based on income that ranges from $250 to $2,500 a year. Once the deductible is met, the plan pays 80 percent.
But enrollment in Maine's program is low. Some said it's still too expensive, and because businesses are required to pay 60 percent of the cost, there's little incentive to offer it.
"We're going to look at a whole range of options," said Andrew Dreyfus, of the Blue Cross Foundation.
Learning from other states is key to formulating the right plan. So far, Blue Cross Foundation has spent $400,000 studying a variety of approaches from expanding Medicaid to requiring people to buy health insurance.
"Some people would argue this is a national problem, but I think we know that this isn't an issue that Washington is going to take on in the current environment. There are other priorities, so it's really one of those issues the states have to deal with," said Dreyfus.
And some believe the timing is right for the governor to work with Democrats to develop affordable health coverage for all.
"It just might be in his interest for whatever his ambitions might be, for Massachusetts to have a universal program, whatever the motivations, if we can get it and help people on a universal program, I'm for it," said U.S. Sen. Edward Kennedy of Massachusetts.
The Blue Cross Foundation will finish up its research this summer and hopes to have it's own plan called a Roadmap to Coverage by the fall.
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Dr. Timothy Johnson Reports On Plans
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