In Massachusetts, where 97% of us have health insurance by mandate since 2006, we have learned a few things about health care reform.

We have learned that universal coverage does not mean universal access to a doctor.  The Massachusetts Medical Society reports that there is a critical shortage of family physicians and severe shortage of internal medicine doctors.  Seven physician specialties are also operating in critical or severe physician labor markets.

A recent study by the Robert Wood Johnson Foundation showed that 75% of non-emergency ER visits occurred because a regular physician was not available after hours, and half of these visits occurred because a timely appointment was unavailable.  With more than half of all the doctors trained in Massachusetts leaving the state, citing the practice environment and low salary levels, and one out of every four currently practicing doctors considering a career change, it does not appear that access issues are going to improve soon.

(more…)

Both the House and Senate versions of the healthcare reform bill would require employers above a certain size to provide health insurance for their workers or face some sort of penalty. The House bill that passed last month would require employers to pay an 8% additional payroll tax for not insuring their workers. The Senate bill now under consideration is much less punitive, requiring employers who do not provide insurance to pay a $750 annual fee per full-time worker, but only if one or more of their employees receive a government subsidy in the insurance exchange.

Quite a difference between the two bills. By way of example, take an employee earning $50,000 per year. Under the House bill, an employer who did not provide insurance would be required to pay an additional tax of $4,000 to the federal government. Compared to only $750 under the Senate bill – a difference of more than 500%.

Now consider whether it would make more sense financially for the employer to provide insurance or pay the penalty. In our example above, under the House bill it would probably be close to a break-even if the employer is providing coverage only for the employee. According to the most recent data from the Bureau of Labor Statistics (BLS), the average monthly insurance premium for private industry employers across all worker categories was $317.63. Or just over $3800 annualized (compared to the $4,000 penalty). However, it would be quite a bit more expensive if the employer was providing family coverage (BLS data: $737.68/mo – $8850/yr).

Obviously under the Senate bill it would be far less expensive for the employer to just pay the $750 penalty rather than provide the insurance.

(more…)