Mass Board May Drop Drug Coverage From Its ‘Universal Coverage’ Plan

Some readers thought I was overly hard on the Massachusetts “universal coverage” plan when it was first announced. I suggested then that it might be as much a “mirage” as a “miracle.”  I thought that the politicians and others who authored this bill spent too much time congratulating themselves, and too little time considering the obstacles left unaddressed by their work product. That includes Democrats and Republicans, as well as business and labor leaders both left and right.

Now the governing board created by the plan is discussing whether to drop the requirement that drug coverage be included in their plans. This is, on the face of it, absurd. You can’t have “universal insurance” without pharmaceutical coverage.

From an underwriting perspective, this idea’s equally wrong-headed. Conditions that could easily be arrested or cured with medication will go untreated until plan participants are forced into hospitals or other high-cost care. The result is bad for the patient and bad for the system.

These discussions are an acknowledgement of what I forecast when the plan was announced: The costs of enrollment are going to be so high that many people will opt to take the penalties rather than sign up, especially in year 1. That creates adverse selection (enrollment of only the sickest), which in turn would most likely lead to soaring premiums in year 2.

At this point, I can’t think of any good options for the Health Connector board. If they insist that drugs be covered, they’ll face compliance and cost problems. If they allow plans that exclude drug coverage, they’ve essentially failed in their mission to provide universal coverage — and they’re created some very real health delivery and financing problems now and in the future.

The best thing they could do is go back to the drawing board by convening a high-level group to lay out realistic options for the public.

I wish the politicians and others had spent a little more time analyzing the problem and a little less time patting themselves on the back before this plan was rolled out.