Massachusetts Insurers Set Out to Enroll Working Poor

Published March 1, 2007

On January 2, Massachusetts kicked off the second wave of enrollment for its individual health insurance mandate, signed into law last April by then-Gov. Mitt Romney (R).

The second wave, aimed at the state’s 100,000 working poor, netted only a few hundred people during its first week, despite the incentives insurance companies are offering–proof that many state residents either don’t want or don’t believe they need health insurance, critics say.

Commonwealth Care, the new state-administered program, requires all Massachusetts residents to have health insurance by July 1 or face penalties that include the loss of a personal income tax deduction.

In October, the state began enrolling residents who live at or below the federal poverty level, marked by an annual income of $9,800 a year for an individual and $20,004 for a family of four.

As of late December, nearly 29,000 people had enrolled in one of the four Commonwealth Care health programs, each administered by a private insurer.

New Hurdle

But a new challenge has arisen: Persuading the state’s 100,000 “working poor”–those individuals who earn more than $9,800 but less than $29,412 annually–to sign up for subsidized health insurance, for which they must pay at least a small monthly premium.

“We’ve been going around the state, trying to educate employer groups,” said Christina Andreoli, a spokeswoman for Fallon Community Health Plan, one of the four plans authorized to sell the subsidized insurance. “Many people aren’t familiar with what’s going on yet.”

The push to enroll uninsured residents involves a combination of marketing and education, Andreoli said. Fallon has not engaged in any mass marketing–no billboards or television ads–but its Web site emphasizes the benefits of choosing Fallon: The company will reimburse each member up to $200 for health club memberships, Weight Watchers memberships, and yoga and Pilates classes.

Those benefits are available to members through the company’s commercial health maintenance organization (HMO) products as well.

Unwanted Product

Fallon’s competitors are offering other enticements to potential members. For example, sign up with Neighborhood Health Plan or Network Health, visit a doctor, and get a $25 retail gift card. Fill out a health questionnaire for the Neighborhood plan and get another $25 gift card.

“There isn’t a way to pinpoint this population,” Andreoli said, adding that the first week of enrollment had yielded a “trickle” of new members, about 250 people.

The heart of the challenge is enticing people by incentive–or penalty–to buy a product they either don’t understand or don’t want.

‘Terrible Idea’

The individual investment in health insurance is a cornerstone of Romney’s support for the policy. The first bullet point in the reform legislation Romney introduced in 2005 is “individual (and family) responsibility for their own health care.”

“It was a terrible idea, and we’ve been through this before,” said Greg Scandlen, president of Consumers for Health Care Choices, an advocacy group based in Maryland, noting Maine and Vermont, which enacted similar mandates over the past three years, haven’t come close to achieving 100 percent coverage.

“Maine passed their law in 2003, and figured they would enroll some 31,000 people in the first year, and as of a couple of months ago, all of 12,000 people had enrolled,” Scandlen said. “We’ve seen this time and time again. Just because the legislature requires everyone to do something doesn’t mean they’re going to do it. I think it just shows incredible hubris on the part of the governing elite in Massachusetts.”

Unanswered Questions

The Commonwealth Care program marks a shift in how state money flows to health care providers, said Steve Poftak, research director of the Pioneer Institute, a nonpartisan policy think tank in Boston.

“The money is flowing through the individual, where it used to flow directly to the provider,” Poftak said, voicing support for that change.

When Romney signed the law last year, most free-market analysts nationwide panned the idea of mandating individual coverage, saying it would be expensive, intrusive, and ineffective–auto insurance mandates have yet to result in 100 percent compliance, they noted.

When asked about the challenges the state faces in enrolling residents who are unfamiliar with or uninterested in health insurance, Poftak pointed to a group of workers in their twenties who could afford health care but chose not to buy it “because they think it’s a bad deal.”

Under the new law, of course, that’s no longer an option.

Hilary Masell Oswald ([email protected]) writes from Illinois.

For more information …

“Individual Mandates,” excerpted from State Briefing Book on Health Care, National Center for Policy Analysis, September 23, 1994,

“Why Governor Romney’s Health Care Reform Won’t Work,” by Michael Tanner, Briefing Papers, Cato Institute, August 6, 2006,

“Analysis: Massachusetts Health Care Plan Intrusive, Expensive,” by Grace-Marie Turner, Health Care News, June 1, 2006,