Kalese Hammonds of the Texas Public Policy Foundation notes the following:
In Massachusetts, the individual mandate and state subsidies have led to massive cost overruns. The newly insured have flooded doctors’ offices, creating a shortage of providers and forcing doctors to either turn down patients or put them on a waiting list.And Grace-Marie Turner of the Heartland Institute notes:
What Massachusetts has found – and what advocates for the uninsured fail to recognize – is that health insurance does not necessarily mean access to health care. In fact, health insurance is partially responsible for the continuing decay of our health care system. Its desensitization of consumers from the cost of health care has created an environment that encourages overutilization.
As the demand for health care services has risen, so have their prices; proof that the economic principles of supply and demand do, in fact, apply to health care.
* It's easy to get people to enroll in health insurance if you make it free or nearly so to them. The great majority of those newly covered by insurance in Massachusetts are in plans completely or heavily subsidized by the taxpayer. Of the 330,000 newly enrolled in insurance, at least 232,000 are getting free or heavily subsidized coverage.These problems will not be solved simply by throwing more money at the system. Because they are a consequence of the government forbidding individuals, providers, and insurers from contracting freely, they will be inherent in any system of mandated insurance.
* The hard part is convincing people who don't get subsidies--and who face growing penalties for not enrolling--to buy insurance. The state government has the audacity to tell residents what they can and cannot afford to pay. For example, if your family income is $70,001, the state says you can afford to spend $550 a month, or $6,600 a year, for health insurance. If you don't buy it or get a waiver, you'll be fined. The penalty now is as much as $1,824 for a couple, and it will increase again next year.
* The plan is starting to strain the state budget as well. Gov. Deval Patrick (D) has asked for $869 million for fiscal 2009, but state authorities warn the cost will be closer to $1.1 billion--about as much as the state pays for its total public safety budget. The state also is concerned about another 30,000-40,000 people who have job-based coverage now but could be added to the subsidy rolls as well.
* Insurance costs continue to rise. The state has approved a 12 percent rate increase for health insurance for next year.
* Some safety net hospitals are threatening bankruptcy. Hospitals are still treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut as part of the reform deal.
* The state is finding its goal of universal coverage to be increasingly elusive. Several hundred thousand people are still without health insurance, and they will be the most difficult to enroll because the majority won't qualify for subsidies. They face rising health insurance costs, growing fines, or a complex waiver process.
* The shortage of primary care doctors is making it difficult in some parts of the state for people who are newly insured to find a doctor who will take new patients. One person wrote us, "Before, I was uninsured and couldn't see a doctor. Then I made the sacrifice to buy insurance, but I still can't find a doctor who will see me. So now I still don't get to see a doctor, but it's just costing me more."
* The state has a detailed list of minimum coverage standards for 2009 that many small businesses will not be able to meet. They find the richer package more expensive than they can afford to buy for their workers. What will the state do? Fine them? Relax its rules again?