Health Care Advocacy: CommonHealth's Inequitable Premiums

People with disabilities continue to be absent from health care planning forums. Dental and eyeglass benefits were restored in July and people with disabilities are thrilled. However, while other advocates were negotiating Chapter 58, people who are deaf were lobbying for hearing aid coverage and people who are blind were asking for a talking prescription bottle to reduce prescription errors. Both benefits were buried by the Reform Bill until 2008.

Common Health

CommonHealth was originally designed as a work incentive program within a health insurance coverage model.  Currently CommonHealth struggles to maintain these goals.  Many CommonHealth enrollees have struggled with rising premium costs as they advance professionally and personally.  CommonHealth must return to its original mandate of providing health insurance while supporting the progress of people with disabilities across the state.

CommonHealth's Inequitable Premiums:   The Disability Marriage Tax

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Recent forums attended by working people with disabilities have revealed that the CommonHealth premium formulas act as a disincentive to working, career advancement and marriage for people with disabilities. In effect, a program whose original objective was to increase incentives for people with disabilities to seek employment, family etc., is through its policies discriminating against the population and imposing a disability marriage tax!

Premium rates reported ranged from $500 to $1000 a month. Sample cases reflective of issues raised within the group reflect the broader challenges facing people with disabilities who are married.

When Mary S. was single with a salary of $35,000, her monthly CommonHealth premium was $152.  At this level Mary's CommonHealth premiums were quite reasonable and in keeping with the stated goals of CommonHealth Care.  See Chart A below for comparison with Commonwealth Choice premiums. *

Chart A

Mary S. is now married to John. Her income of $35,000 combined with John's salary of $56,000 a year is $89,000 a year. Her premium is now $474 per month or $5688. While Mary's income has increased as a result of her marriage, the tripling of her insurance premiums is not in keeping with the goals of Commonwealth Care and is actually discriminatory. See Chart B below for monetary comparison with Commonwealth Choice premiums for married couples.

Chart B

*All people with disabilities covered by CommonHealth have a disincentive to seek higher paying jobs because their premiums will increase with their income, in stark contrast with their counterparts on Commonwealth Choice who pay a flat rate regardless of income increases i.e. able-bodied person making $150,000 will still pay the same rights as an able-bodied person making $35,000 a year.

Because the state requires all residents to have health insurance coverage the couple is further penalized when the premium rates for John's health insurance are included in the equation.   See Chart C below.

Chart C

Chart C clearly exposes the unreasonable undue hardship placed on Mary and John as well as other couples in which one spouse is disabled and covered by CommonHealth. Couples in which one spouse is disabled:

• because CommonHealth does not cover a nondisabled spouse must purchase two health insurance policies elevating the financial burden placed on the couple to unreasonable levels.
• are subject to CommonHealth premium penalties resulting from increases in family income. 

These penalties do not exist for nondisabled residents of Massachusetts and therefore constitute overt discrimination against people with disabilities.

• Nondisabled couples have the choice maintaining individual health policies or getting a single family policy. This option does not exist for couples in which one spouse has a disability and is discriminatory. 
• Nondisabled couples are not subject to premium penalties resulting from increases in family income.

Another example of how the disability marriage tax discriminates against people disabilities is apparent in the case of Carlos C. Carlos C. is married, and employed in an entity that provides health insurance which by law Carlos is required to accept; a cost of $591 per month. In addition to the health insurance provided by his employer Carlos, also carries a wraparound insurance policy through CommonHealth; a cost of $498 per month. In addition to premiums co-payments and out-of-pocket expenses cost Carlos an average of $100 per month. See Chart D below for Carlos C. medical expenses.

Chart D

For people like Carlos using the CommonHealth wrap-around coverage, the wraparound is often more expensive than the private insurance itself. Having to maintain both insurances becomes an economic noose strangling people with disabilities and if married, their spouses. Participants reported monthly private insurance premiums of $100-200 (with employer contribution deducted) and a $400+ CommonHealth premium. This brings total monthly premium costs to an unacceptably large sum of approximately $600 dollars per month excluding out-of-pocket medical expenses.

The disincentives for Carlos and his wife to seek increased job security and salary are glaringly apparent. Also apparent is the disincentive for Carlos to work at all. Why should Mary or Carlos seek employment if their medical expenses increase with their income. Many people disabilities like Mary and Carlos decide not to work because of the associated health care costs; the costs outweigh the benefits. And sadly too many people with disabilities cannot economically justify getting married or even staying married because of the associated costs. In fact, participants in the focus group discussed the possibility of dissolving their marriages in order to not only maintain a sustainable wage but to save their relationships from the financial and emotional burden placed on a nondisabled spouse.

It is in Massachusetts’ vested interest to remove barriers that prevent people with disabilities from engaging in gainful employment and seeking stable living situations. Instead, as these examples illustrate, the state is penalizing people for seeking greater financial independence and a stable home life. The disability marriage tax works against the state's interests and at the same time harms people with disabilities.

The inequity in CommonHealth premiums for working families must be addressed by policy makers. The emphasis of the Commonwealth of Massachusetts on requiring health insurance for all residents through the Connector Authority and the considerations given to keeping premiums as low as possible is admirable. The same consideration should be extended to working families of people with disabilities. Massachusetts must do away with the disability marriage tax for people with disabilities.

- Dennis Heaphy, May 2008