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Why the fate of health reform lies in states' hands

By Suzy Khimm

Though reform opponents have derided the Affordable Care Act for being a "federal takeover" of the health-care system, the new health law actually leaves a lot up to the states.

Take the creation of the new state-based insurance exchanges, which are intended to provide more affordable and accessible coverage to individuals and small businesses. Due to pressure from more conservative members, the Senate ended up adopting a state-based system instead of the national exchange in the House bill, paving the way for the current law. Though there will be federal rules and regulations for the exchanges, each state is tasked with creating and administering them. So state officials — both elected and appointed — will be bearing a lot of responsibility for enacting reform and regulating the insurance market.

Some states have already beefed up their oversight of the health-care system and insurance market, and the regulatory battles they’re facing portend the kind of challenges that officials will be facing on the state level. In Massachusetts yesterday, the state’s Division of Insurance rejected “235 of 274 increases proposed by Massachusetts health insurers for small businesses and individuals ... mark[ing] the first time state government in Massachusetts has used its authority to deny health premium increases," the Boston Globe reports. The ruling makes good on a promise made by Gov. Deval Patrick to turn down excessive price increases.

And in Maine, there’s an ongoing legal battle over a state insurance regulator’s decision to reject an insurance company’s request for a premium hike last year. Anthem Blue Cross and Blue Shield, which is part of WellPoint, argues that they needed the premium increase to turn a profit during the recession. Contesting the state ruling in court, Anthem maintains that the insurance regulator’s decision had “zeroed out its profit to keep customer rates down” in the individual market, according to the Wall Street Journal.

As the Journal notes, there are at least 29 states that give state regulators direct authority over premium rates. And the arrival of new insurance exchanges, which have to be set up by 2014, will only expand their responsibilities and the scope of these officials’ authority. Though the federal government is responsible, under the new health law, for examining “unreasonable increases” in premiums, most of the oversight will be in the states’ hands. Massachusetts and Maine have adopted reforms that are quite similar to key elements of the new health law, and the outcomes of the current battles could end up setting a precedent for way that state officials will be able to shape the insurance market and implement the new health law.

And by leaving so much up to the states, the health law could end up creating a system in which there are significant disparities in health coverage and insurance regulation, at least partly depending on political will. As I explained in a recent piece for Mother Jones, “reform-resistant state governments will have much opportunity for foot-dragging and spotty regulatory enforcement” because of their new responsibilities under the health law.

On the flip side, there are blue states that have been aggressive about starting to enact the new health law, at times going above and beyond what they call for. That Deval Patrick is running for reelection this year — against a former insurance executive, no less — hasn’t escaped the attention of Massachusetts insurance lobbyists, who have accused the governor of playing politics after the state rejected the premium hikes this week. And as more state governments begin to adopt the reforms required by new health law, these kinds of state-level battles are likely to play out across the country.

— Suzy Khimm is a journalist who covered health-care reform at the New Republic and is now a political reporter at Mother Jones.

By Washington Post Editors  |  April 2, 2010; 12:00 PM ET
 
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April 02, 2010
ObamaCare's Economic Dominoes

Now that health care reform in the shabby disguise of ObamaCare has been crammed through Congress, a peek at the president's precariously stacked dominoes confirms that sooner than you may suppose, there won't be any private companies selling health insurance in America. Consider:


There are approximately 1,300 insurance companies in America today.


Beginning January 1, 2011, these companies will be required to pay out 85% of all premiums collected as direct medical care, leaving 15% of corporate income to fund operations and yield any potential profit.


The health care industry has a profit margin of about 3%. Most American businesses rely on securing annual profits of 8% to 10%. American oil companies operate on about 4% profit. Alcoholic beverage sales net annual profits of 26%.


To maintain even slim profitability or cash reserves, insurers will be compelled to run austerely.


Why?


Posted by: Bubbette1 | April 2, 2010 1:04 PM | Report abuse

Among numerous regulations implemented immediately, ObamaCare cannot deny children with preexisting illnesses coverage, no matter the illness, no matter the long-term cost -- and children are now "children" until age 26. It is irrelevant there may never have been any contribution for such children into an aggregated "risk pool" of insurance policy purchasers -- the very idea of which is to "spread the risk" around. They will be able to have all their medical costs paid for by the responsibility and forethought of unrelated others.


Adults currently uninsured due either to preexisting illness or choice can now buy into government-run and guaranteed plans which insurance companies will in essence be required to assume beginning 2014, when they will no longer be allowed to exclude anyone based on actuarial or other rational data standards.


Posted by: Bubbette1 | April 2, 2010 1:06 PM | Report abuse

Costs for insurers will further increase as they pay more and larger amounts in claims that have no dollar ceiling -- they are immediately banned from implementing lifetime caps on coverage.


Under ObamaCare, once subsidized purchases begin no later than 2014, millions of formerly uninsured will be eligible for federal subsidies to help purchase coverage they can already afford but choose not to buy. There are currently eight million uninsured Americans earning over $50,000 a year and another nine million uninsured Americans earning in excess of $75,000 a year who willfully play medical roulette by refusing to purchase health care insurance for their dependents. Nevertheless, a family of four with an income of $88,000 a year will be eligible for financial aid.


Healthy, and especially young, people will predictably opt to pay the $750 ObamaCare fine assessed for failure to purchase coverage since it is less than the yearly cost of insurance premiums. Quite literally, there will be no need to purchase "insurance." One can simply wait until illness or accident strike, but in the meantime spend money in other ways.


Posted by: Bubbette1 | April 2, 2010 1:07 PM | Report abuse

More and more workers and families who previously sustained the business of insurance companies will weary of witnessing millions of Americans game the system and take a free ride. Formerly responsible citizens will allow their health care coverage to lapse and adopt the same wait-and-see attitude. If an emergency occurs, they too will have failed to pay into a health care risk pool for months or years, but their medical bills will be paid -- by insurance companies who received nothing from them or millions of others who made similar self-referential decisions.


As payouts broaden and escalate, insurers will not have sufficient financial resources to operate within the allowable 15% of gross income. Forced to meet the 85% mandatory payout threshold, they will do one of two things -- raise premiums on those diminishing customers actually purchasing insurance or cut costs.


Business operating expenses include a vast array of liabilities, from buildings and taxes to furniture and computers, but after medical care payouts are made, insurance companies' biggest cost center is personnel -- which is where cuts have already begun.


Posted by: Bubbette1 | April 2, 2010 1:08 PM | Report abuse

As staff reductions continue, tens of thousands of insurance industry employees will be thrown out of work -- estimates run as high as 690,000. These are American workers with spouses and children, mortgages and car notes, food bills, utility bills, and hundreds of other financial responsibilities. Unemployed, they will add to the worsening overall economic situation and be remanded into the ranks of the fully subsidized health "insured."


The dominoes won't stop falling there.


Many more than just direct insurance personnel will be affected. As cutbacks intensify, reliance by insurers upon various vendors and suppliers will be curtailed and terminated. Independent brokers will no longer receive business as insurance companies take direct sales and other functions back in-house. Hundreds of related external service providers will be cut or canceled, as will their employees when work supply exceeds demand.


Posted by: Bubbette1 | April 2, 2010 1:09 PM | Report abuse

Massive increases in the use of medical services will overload doctors' and hospitals' ability to provide adequate care. It will become rationed as too many people chase too few services too much of the time at too great a tab because too few people contributed too little money to its actual cost. Physicians and pharmacists who accept Medicare and Medicaid reimbursements will continue to see earnings both diminish and become more government-controlled. At the same time, medical innovation will slow if not cease because ObamaCare levies a massive new excise tax on medical device manufacturers. They will stop "innovating," and many go out of business, unable to pay the cost of business in a nationalized industry -- literally taxed to death. The inevitable result will be fewer doctors, fewer specialists, and greatly reduced and rationed care.


Add to this statist medical assurance the fact that incrementalist Democrats fully intend, eventually, to provide universal care to over 12 million illegal foreign aliens, and the rising price of medical care defies comprehension. Illegal aliens, like millions of freeloading citizens, will have paid little or nothing for benefits parasitically leeched from the insurance industry, the economy, and the American ideal -- which until the past few decades didn't include an ever-enlarging entitlement appetite of something for nothing.


Finally, "risk pools" will have filled -- overpopulated with people who have rarely or never paid into the health care system before and who, even if not extremely or expensively ill, will contribute to the crisis of underfunded overutilization. Insurance companies will run out of costs to cut and people to lay off. They will cease to do business, existing only as collection points for government oversight. Taxes will rise exorbitantly to pay for "free" universal health care. Socialized medicine will reign.


Posted by: Bubbette1 | April 2, 2010 1:10 PM | Report abuse

Americans will have the single-payer health care system President Obama and the extreme Left-dominated Democrat Party and Congress have explicitly schemed towards for seven decades: the federal government. And the system will no doubt be underwritten by confiscatory taxation.


One-sixth of the United States economy will transform into an even larger percentage due to the complete destruction of an industry, hugely magnified unemployment, and overutilization of underfunded, mandated medical care and resources.


The economic chaos resulting from ObamaCare will trigger the collapse of one economic domino after another. As it does, America will become a statist's Socialist's dream, but an unqualified socialized nightmare. The human cost in this is incalculable, but quite easy to imagine.


Thank an Obama voter today.

http://www.americanthinker.com/2010/04/

obamacares_economic_dominoes.html

Posted by: Bubbette1 | April 2, 2010 1:10 PM | Report abuse

Ask any tbagger to give you 1 specific - emphasize SPECIFIC - objection they have to HCR and guess what you get?? that's right ZERO. David Frum is the only Republican left who speaks thoughtfully, logically and with impeccable integrity - and they FIRED him for not parroting the party line. Fact is, perfection is IMPOSSIBLE, but the status quo is just more insanity and economic damage.
So we got a bill that will have some flaws - DUH! Let's fix those flaws and move on. The hysteria of the angry mob mentality is so infantile and irrelavant. GOD BLESS AMERICA>

Posted by: truthseeker13 | April 2, 2010 1:14 PM | Report abuse

I don't have a problem with zeroing out insurance company profits. The whole problem with health insurance as a for-profit business is the perverse incentives - the less care you provide, the less sick people you insure, the more money you make. Don't some countries require their health insurance companies to be non-profit? Is there something in the constitution that guarantees that corporations make huge profits?

Posted by: randrewm | April 2, 2010 1:31 PM | Report abuse

Since the States are responsible for implimenting this new insurance coverage, how many new state employees will it take?

California (where I reside) is hurting due to the recession. So, my understanding is, for the next 4 years they will create this new insurance pool using whose money?

If these new employees become CSEA (California State Employees Assoc.) members, their insurance and retirement benefits are paid for by the taxpayer. That exempts them from this new healthcare and throws the burden on the taxpayers. Adds retirement benefits to the taxpayers' responsibility. Where is the savings?

Since the insurance companies can no longer plan to make a profit, how many of their employees will be on the unemployment line?

Another question is: How much money is it going to actually cost me in the future for insurance. Where are the rate charts comparing what I pay now to what I will pay in the future?

Posted by: alscoins | April 2, 2010 2:52 PM | Report abuse

Other questions that need to be addressed:

1. When people move from state to state, how will this effect their insurance?

2. How will the state employees verify if a person is an illegal or not?

3. Since the doctors will be very busy treating their new patients, who will be incharge of authorizing procedures?

4. How will it be determined if the patient is who they claim to be?

5. How many states can a person register for insurance care in if they own multiple residents?

6. Will we need a medical card similar to passports?

Posted by: alscoins | April 2, 2010 3:07 PM | Report abuse

"1. When people move from state to state, how will this effect their insurance?"

The same way it does now, since insurance companies are presently chartered and regulated in individual states.

"2. How will the state employees verify if a person is an illegal or not?"

Undocumented people will not be able to obtain the insurance subsidies, since the subsidies are in the form of Federal income tax credits.

"3. Since the doctors will be very busy treating their new patients, who will be in charge of authorizing procedures?"

Please bear in mind that the system is administered by private insurers, so coverage determinations on specific procedures will be made by the insurer.

"4. How will it be determined if the patient is who they claim to be?"

Again, just like now, you will present a card issued by the private insurance company that will be billed for your care,

"5. How many states can a person register for insurance care in if they own multiple residents?"

You will have insurance through your employer, or purchase a policy in the state of principal residence. That would be the state where you vote, pay taxes, receive resident status for any kids in public universities, etc.

"6. Will we need a medical card similar to passports?"

No, you will carry a card from your private insurance company, just as you do today.

Posted by: Patrick_M | April 2, 2010 3:37 PM | Report abuse

"Since the States are responsible for implimenting this new insurance coverage, how many new state employees will it take?

California (where I reside) is hurting due to the recession. So, my understanding is, for the next 4 years they will create this new insurance pool using whose money?

If these new employees become CSEA (California State Employees Assoc.) members, their insurance and retirement benefits are paid for by the taxpayer. That exempts them from this new healthcare and throws the burden on the taxpayers. Adds retirement benefits to the taxpayers' responsibility. Where is the savings?

Since the insurance companies can no longer plan to make a profit, how many of their employees will be on the unemployment line?

Another question is: How much money is it going to actually cost me in the future for insurance. Where are the rate charts comparing what I pay now to what I will pay in the future?"


alscoins,

It should not require a large number of number of new employees at the state level to qualify insurers to participate in the exchanges. Most likely your Governor will appoint a Commission that will work together with the already existing regulatory authority.

Insurance companies will certainly continue to "plan to make a profit" and they will have millions of new paid customers. The insurers simply are required to compete on the exchanges to win the new customers, and the guidelines for the percentage of revenues they must pay out in claims will still leave room for enormous profit. I would not lay awake nights worrying that employees of private insurance companies are heading for the unemployment lines...on the contrary, they will have more customers and more claims to handle than ever before.

There are no rate charts that tell you what health insurance will cost in the future, and there were no such charts before reform. Everyone expects that the costs of health care will continue to rise, but the expectation is that the escalation of costs will be less severe as a result of the reforms, and that millions of people who have been previously unable to access care because of cost, pre-exisitng conditions, etc., will finally be able to obtain care at an affordable cost.

Posted by: Patrick_M | April 2, 2010 3:59 PM | Report abuse

It is the duty of a state insurance commissioner to insure that insurance rates and insurance reserves are adequate (as well as the rates not being excessive). If rates and reserves are not adequate then the insurance company may fail and claims may not be paid.

Insurance policies are sold before the cost of the product is known. Historically insurance rates have been actuarial based. With this health care reform insurance companies become regulated utilities with rates that are political based (e.g., women and men have same rates, no pre-existing conditions, older folks pay no more than 3 times younger folks, insurance companies have to pay 80%+ of rates in actual medical payments and can spend no more than 20% on expenses).

That complicates rate making and if I were an insurance company I would raise rates to the maximum and refund based on the 80% rule. In a new environment where it is not possible to determine rates based on experience, it is the only business decision they can/should make to protect their solvency and their ability to pay claims to the insured.

Posted by: LewisE | April 2, 2010 4:02 PM | Report abuse

"I don't have a problem with zeroing out insurance company profits. The whole problem with health insurance as a for-profit business is the perverse incentives - the less care you provide, the less sick people you insure, the more money you make. Don't some countries require their health insurance companies to be non-profit? Is there something in the constitution that guarantees that corporations make huge profits?"


There was some talk about creating non-profit insurance co-ops as an alternative compromise to the public option, but that talk never went anywhere. It seems more logical to either preserve the exisiting for profit system, or to have a "robust" public option like a Medicare buy-in, rather than to attempt to create private non-profit entities to provide insurance services.

Nothing in the constitution "guarantees" profitability to any private for-profit corporation, but I think you would run into enormous legal and political problems if you wanted to suddenly legislate that they all be converted into 501c3 non-profits. What would become of the shareholders' equity, etc.?

I think you must either leave profit-motivated insurers in place (as HCR has done), or leave them in place but with a public option that competes for enrollees alongside the for-profits, or else go all the way to a single payer health care delivery system, and remove the private insurance model entirely. Those three approaches are really the only viable alternatives.

Posted by: Patrick_M | April 2, 2010 4:23 PM | Report abuse

"That complicates rate making and if I were an insurance company I would raise rates to the maximum and refund based on the 80% rule. In a new environment where it is not possible to determine rates based on experience, it is the only business decision they can/should make to protect their solvency and their ability to pay claims to the insured."

Insurers by and large are already paying out MLRs well above the now mandatory 80% threshold, so using that threshold as an excuse to raise premiums would be completely inappropriate and would get them into immediate trouble with state regulators. The other factors you cite (guaranteed issue, etc.) are counter-balanced by the increased premiums that will come from the mandate. Premiums will continue to be adjusted based on actuarial data and the real world costs of providing the insurance coverage.

Posted by: Patrick_M | April 2, 2010 4:35 PM | Report abuse

"The economic chaos resulting from ObamaCare will trigger the collapse of one economic domino after another. As it does, America will become a statist's Socialist's dream, but an unqualified socialized nightmare. The human cost in this is incalculable, but quite easy to imagine."


Your hysterical conclusion, just like all of the false assumptions and non-factual statements that precede it, is utter lunacy.

Posted by: Patrick_M | April 2, 2010 5:08 PM | Report abuse

People with any intelligence understand that when you require insurance companies to take all comers no matter what their situation, limit their profits and set the fine for not buying insurance so low that almost no one will sign up until they are sick that the insurance companies will eventually go out of business.
As Obama himself has stated numerous times, this new Obamacare law is just the beginning. The toe in the door for the Democratic dream of single payer and once the insurance companies are out of business single payer will be a reality.

Posted by: RobT1 | April 2, 2010 5:28 PM | Report abuse

"People with any intelligence understand that when you require insurance companies to take all comers no matter what their situation, limit their profits and set the fine for not buying insurance so low that almost no one will sign up until they are sick that the insurance companies will eventually go out of business.
As Obama himself has stated numerous times, this new Obamacare law is just the beginning. The toe in the door for the Democratic dream of single payer and once the insurance companies are out of business single payer will be a reality."


Here is what "people of any intelligence" actually do understand.

Guaranteed issue is counterbalanced by the addition of many new low risk customers.

There is no limit placed on insurance company profits, just a sensible minimum MLR ratio (which insurers have historically exceeded).

You cannot support your contention that "the fine for not buying insurance [is] so low that almost no one will sign up until they are sick." The uninsured will buy health insurance when they can afford to buy it. Do you think that if you suffer a heart attack or stroke that you will be able to call your insurance broker and mail a check to enroll in an insurance plan during the fraction of a second before you collapse to the floor? "People with any intelligence" don't think so.

"...the insurance companies will eventually go out of business." The reforms bring millions of new customers to the insurance companies. We go from an era in which the proportion of uninsured were rising, to an era in which nearly every American is assured access to health coverage through the private insurance companies. That is hardly the path to bankruptcy for the private insurance industry.

"People with any intelligence" can see that this plan was a RESCUE of the American private health insurance system. The insurance companies are NOT going out of business, as the value of their stocks will tell you.

Posted by: Patrick_M | April 2, 2010 6:01 PM | Report abuse

This is a great discussion. Maine and Massachusetts are among the states with the highest payouts per Medicaid recipient. As the significant disparities become more apparent, there will be significant questions regarding the PPACA.

A loaf of bread should, but does not, cost every taxpayer the same amount: why should some taxpayers be asked to pay for an expensive loafers' bread?

Posted by: rmgregory | April 2, 2010 8:00 PM | Report abuse

"Maine and Massachusetts are among the states with the highest payouts per Medicaid recipient. As the significant disparities become more apparent, there will be significant questions regarding the PPACA.

A loaf of bread should, but does not, cost every taxpayer the same amount: why should some taxpayers be asked to pay for an expensive loafers' bread?"

Really?

State Medicaid programs vary in their generosity, their standards of eligibility, allowable benefits, and this has an effect on their reimbursements for health care. Payout per recipent is also determined partly by the state's demographics (a low income elderly Medicaid receipient in a nursing home will naturally require a higher payout than a typical low income child).

If you are arguing that disparities in payout per recipient are somehow unfair to taxpayers, you would be arguing that (a) Medicaid should become entirely federalized, and that (b) every low income person who requires medical care must somehow require exactly the same dollar amount of care as every other recipient in the system.

Obviously health care "benefits" paid out (whether by a private insurer or a means tested public program like Medicaid) will always vary according to the individual circumstances of each recipient's own health. Disparities are to be expected.

Posted by: Patrick_M | April 2, 2010 8:40 PM | Report abuse

My insurer, Blue Cross Blue Shield of Massachusetts, lost $150 million last year. How are they to remain solvent if Governor Patrick and his cronies won't allow them to raise rates to break-even levels?

Now there's nothing to stop a liberal zealot like Patrick from forcing insurers into bankruptcy, and then imposing the same single-payer system that he's wanted from the start.

Posted by: mike_w_long | April 3, 2010 8:14 AM | Report abuse

Private insurers should be treated as regulated utilities. And if they can't operate profitably then a single payer is optimal.

Posted by: ElrodinTennessee | April 3, 2010 10:13 AM | Report abuse

"My insurer, Blue Cross Blue Shield of Massachusetts, lost $150 million last year. How are they to remain solvent if Governor Patrick and his cronies won't allow them to raise rates to break-even levels?"


The state of Massachusetts approved some rate hikes and turned down others. No insurer in Massachusetts is teetering on the edge of bankruptcy because premium increases are subject to review.

Your insurer attributes more than 2/3 of their one time loss to "a write-off of certain investment assets." If you are anxious to have your insurer hike annual premiums by as much as 42% in order to cover a one time adjustment on its balance sheet unrelated to the payment of medical claims, by all means complain to your Governor that your premiums are too low to cover all the bad investments made by your insurer.

Posted by: Patrick_M | April 3, 2010 12:40 PM | Report abuse

Many Democrats and Independents in 2008 turned out to vote like never before because they thought they were bringing back the liberal idealism of FDR. The change they were voting for was to reverse the Reagan destruction, to have We The People take up where FDR and Johnson left off. Instead they got a Rockefeller Republican. ------- The Democratic Party and Obama did not learn The Message Of Massachusetts, which is to kick the corporations out the door and implement the change I alluded to. When they see the future MASSIVE Massachusetts-style staying-home and protest voting by these 2008 Obama voters, they will regret not heeding the message. ------- A more specific part of The Message Of Massachusetts is that voucher programs aren't good in comparison to decently financed universal government services, especially as we see what happens when we go down the income scale. People intuitively know this, which is why they understand at least subconsciously that this voucher system is not in the same league as things like Social Security, Medicare, and public schools. They understand at least subconsciously the disaster that would happen if these great liberal and progressive programs were privatized. ------- This intuition is proved by Massachusetts. About 20% of Massachusetts still cannot afford the healthcare they need in spite of being "covered" with "insurance" - even with vouchers they still cannot afford the premiums and/or deductibles and/or copays. This percentage will do nothing but grow without end.

Posted by: Keefanda | April 4, 2010 2:17 AM | Report abuse

And as a result, speaking as a self-employed person that used to be able to buy his own healthcare insurance, Massacuhsetts government has completely screwed up the health care system here. Because of government intervention, my health insurer stopped insuring the self employed directly (now selling only to groups) The insurer said to go to the "Romneycare exchange" where I'd be part of a group getting much better rates (does this all sound familiar, America?) But, instead, the Mass State healthcare welfare exchange sells the same policy I used to get direct for $600 a month for $750 month. Saving you the math, that's 20 percent MORE!!! Where does the 20% broker fee go?

Posted by: byrondennis | April 4, 2010 7:47 AM | Report abuse

"Many Democrats and Independents in 2008 turned out to vote like never before because they thought they were bringing back the liberal idealism of FDR. The change they were voting for was to reverse the Reagan destruction, to have We The People take up where FDR and Johnson left off. Instead they got a Rockefeller Republican."

If you thought Obama was campaigning for single payer health care, then you were paying no attention to his campaign.

"The Message Of Massachusetts is that voucher programs aren't good in comparison to decently financed universal government services..."

Martha Coakley ran a godawful campaign and lost by 5 points. The "message of Massachusetts" is that even a mediocre Democratic candidate would have picked up the extra 3% needed to beat Scott Brown.

If the Democrats protest incremental change by staying away from the polls and allowing Republicans to elect themselves, then the Democrats can expect a reactionary return to the policies of Bush-Cheney.

Is the ACA a near mirror image of what Bob Dole offered in 1993? Yes. Is it better than the old status quo to end exclusions for pre-ex, end lifetime and and annual caps, end recission, close the doughnut hole for seniors and give them paid preventative care, raise the maximum income for medicaid, and offer subsidies that will allow millions of uninsured Americans to access health care? I think so.

The fact that this bill draws criticism from both the right and the left is a prima facie indication that this is precisely the level of reform to our privatized system that could manage to get through the Congress in the era in which we live. If, as many progressives fear, the ACA will not adequately flatten costs and promote universal access, more changes will undobtedly be made in the decades to come. But unless and until that proves to be true, we at least have now enabled better access to medical care, and the result will be fewer deaths and a higher quality of life for millions of people.

Posted by: Patrick_M | April 4, 2010 11:15 AM | Report abuse

byrondennis,

I am curious to know how many companies participate in the Massachusetts exchange, and how many plans are currently available to individuals?

Posted by: Patrick_M | April 4, 2010 11:46 AM | Report abuse

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