Monday, January 5, 2004

A story published today by the Boston Business Journal reports that Massachusetts legislators attempting to control escalating costs placed a lid on new enrollment for unmarried adults as part of the 2004 fiscal budget. But state officials have repeatedly delayed implementing the change, pending federal approval.

For now, this means the Insurance Partnership Program, the 4,000 participating employers and the 13,000 employees and their family members who benefit from the initiative gain a temporary reprieve. But the delays are creating ongoing uncertainty as demand for the 3-year-old program's services rises along with escalating health care insurance costs.

"It makes it a little bit difficult to plan for the future when you have a pending enrollment cap," said Peter Terry, the IPP's program manager and vice president of Employee Benefit Resources Insurance Brokerage Inc. in Wellesley.

"A lot of people who wouldn't look at the program and didn't qualify when the program started, many of these people are now eligible," he said, with one of the largest shifts in interest coming from self-employed people.

Employees can participate in the IPP if they earn less than 200 percent of the federal poverty level, which varies depending on the number of dependents but amounts to roughly $17,900 annually for a single person. A business-owner pays half the cost of an employee's premium and the employee and IPP subsidies would cover the difference.

On average, unmarried workers in Massachusetts pay $320 per month for their private health insurance, and families pay about $850 per month.

Gov. Mitt Romney early last year proposed restricting the program by ending enrollment for adults without dependent children and tightening eligibility requirements for remaining employees, as part of overall MassHealth reforms.

Legislators in June approved an enrollment cap on single people, set at 4,750 adults. About 4,400 single adults were enrolled in the program as of Nov. 30, said Heather Bisset, a spokeswoman for the state Division of Medical Assistance, which oversees the program. Families with dependent children are exempt from the cap.

For now, the cap is slated to take effect as soon as the federal government approves it. And that doesn't make Robert Bigelow happy. Bigelow is vice president and treasurer of Nu-Truss Inc. in Westfield, a 12-employee company that makes wooden trusses for commercial and residential roofs and floors. He's participated in IPP since its launch three years ago.

"It's the only means by which I can afford to offer my employees health insurance," he said.

A cap on new unmarried employees would hurt his company's bottom line, he said, because many of his employees are in common-law arrangements and insured as individuals.

But Bisset said the cap is necessary to maintain the program amid the state's fiscal crisis, and that it won't affect anyone currently enrolled. Those shut out by the cap will be placed on a waiting list and enrolled on a first-come, first-served basis as the enrollment dips below the cap.

Bisset said the state continues to support the program, for which it budgeted $21 million in fiscal 2003. About $37 million has been appropriated for IPP in fiscal 2004, half of which is reimbursed by the federal government. But with health care costs still rising at a rate in the low double digits, caps are still necessary, she said, to keep spending in check.

Meanwhile, at least three bills are pending at the State House that would expand the IPP to cover more people and allow more small businesses to qualify.