Wikipedia is a far left wing web site that pretends to present impartial information to readers for free. In addition to its political bent, Wikipedia has the disadvantage of being consistently very wrong. But – not unrelated -- Wikipedia has the advantage that anyone can go on the site and change the words. But this advantage leads to
1.) the consistent errors noted previously and
2.) the left-wing bent because as soon as someone make an article accurate, some lefty comes along and changes it to whatever he or she thinks is politically correct.
With this in mind, I recently corrected the Wikipedia article concerning RomneyCare. By now the lefties have probably changed it back to the inaccurate mismash it was before I looked at it (you can tell by viewing the history tab).
What follows below is what Wikipedia should really say about RomneyCare1
"The Massachusetts health care insurance reform law, informally referred to as RomneyCare, and officially entitled 'An Act Providing Access to Affordable, Quality, Accountable Health Care,' is a Massachusetts state law enacted in 2006, signed into law by then-governor Mitt Romney. RomneyCare was changed significantly by major amendments in 2008, 2010 and 2012, after Romney left office. RomneyCare has now effectively been repealed, both indirectly by the effects of the U.S. Patient Protection and Affordable Care Act (PPACA) of 2010 as amended and directly by the 2012 Massachusetts state amendment, which replaced RomneyCare's market orientation (which is similar to PPACA's market orientation) with rigid state-mandated price controls on health care.
"RomneyCare mandated that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provided free network-tiered health care insurance for residents earning less than 150% of the federal poverty level (FPL), but ineligible for Medicaid. Partial subsidies were provided for residents -- who qualified -- that made between 151% and 300% of the FPL (as opposed to 400% in PPACA). RomneyCare covered approximately 400,000 of the state's then 600,000 uninsured residents, half via Federal-government-paid-for Medicaid expansion (similar to an analogous portion of PPACA that is going into affect nationwide in 2014 in states that choose the PPACA Medicaid expansion) and half via the free and almost free network-tiered RomneyCare insurance for those not eligible for the expanded Medicaid program.
"Among its many effects, RomneyCare and its amendments established an independent public authority, the Commonwealth Health Insurance Connector Authority, also known as the Health Connector. It was through the Connector that the residents not eligible for Medicaid receiving the free and almost free network-tiered health care insurance signed up for their insurance (after they applied for and were turned down for Medicaid). Among other roles, the Connector also acted as an insurance broker to offer other (not the same as the free or subsidized insurance) private insurance plans to residents. The Connector continues in an analogous role under PPACA.
"The initial RomneyCare legislation also included tax penalties on residents that failed to obtain an insurance plan, and tax penalties on employers with more than 10 full-time employees that fail to offer an insurance plan to employees. The employer mandate was repealed by the Massachusetts state legislature in 2013, in anticipation of a similar but less stringent mandate in PPACA. (NOTE: The national employer mandate in PPACA was waived by the Obama administration for 2014.) Massachusetts' individual penalty has been replaced by the Federal mandate in PPACA.
"The RomneyCare healthcare insurance reform law was enacted as Chapter 58 of the Acts of 2006 of the Massachusetts General Court; its long form title is An Act Providing Access to Affordable, Quality, Accountable Health Care. In October 2006, January 2007, and November 2007, bills were enacted that amended and made technical corrections to the statute. In 2008 and 2010, much more substantive changes were made to the law, one of the most important of which was to begin an open enrollment period for those receiving subsidized health insurance and anyone buying insurance – even if paying full price – as an individual. The major goal of the 2012 amendment is to introduce price controls on health care itself; it is not directly related to healthcare insurance as are the earlier legislative actions.
"Allegedly because of their lack of health insurance, uninsured Massachusetts residents commonly utilize emergency rooms as a source of primary care. The United States Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986.2 EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. EMTALA applies to virtually all hospitals in the U.S but includes no provisions for reimbursement. EMTALA is therefore considered an "unfunded safety net program" for patients seeking care at the nation's emergency rooms. As a result of the 1986 EMTALA legislation, hospitals across the country faced unpaid bills and mounting expenses to care for the uninsured. Data following enactment of mandatory insurance show total emergency visits and spending continued to increase, and low-severity emergency visits decreased less than 2%; researchers concluded, "To the extent that policymakers expected a substantial decrease in overall and low-severity ED visits, this study does not support those expectations." Other analysis concluded that preventable ED visits were reduced 5-8% for non-urgent or primary care ED visits relative to other states. Another report released in January 2012 found between 2006 and 2010 emergency department visits and non-urgent visits had dropped 1.9 and 3.8% respectively
"In Massachusetts, a pool of over $1 billion in 2004/2005, funded by a tax on paying hospital customers and insurance premiums, known as the Uncompensated Care Pool (or "free care pool"), was used to partially reimburse hospitals and health centers for these ED expenses. A much larger portion of the pool was used for non-ED hospital care for the uninsured and for other care at Community Health Centers. It was predicted that implementation of the 2006 Massachusetts healthcare insurance reform law would result in almost complete elimination of the need for this fund. In 2006, an MIT economics professor Jonathan Gruber predicted that the amount of money in the "free care pool" would be sufficient to pay for reform legislation without requiring additional funding or taxes. In fact, during the years before RomneyCare's effective repeal, the state still used the free care pool -- renamed the Health Safety Net -- both as originally intended and to fund the subsidies for free (under 150% of FPL) and almost free (151%-300% of FPL) networked health care insurance. In addition the state spent a substantial amount of general revenue on the insurance reform. Based on the combination of the increased Health Safety Net tax, general revenue (state income and sales taxes were increased 20%) and smaller additional taxes, the cost of the reform reached about 2% of the state's annual budget in fiscal year 2013, which ended June 30, 2013, up from 1.5% in fiscal 2011. Overall the state spent over 50% of its budget on healthcare insurance and related expenses prior to the effective repeal of RomneyCare.
"Commonwealth Health Insurance Connector Authority
"The Health Connector is designed as a clearinghouse for insurance plans and payments. It performed the following functions (almost all of which have been eliminated or substantially changed by PPACA):
- It administers the Commonwealth Care program for low-income residents (up to 300% of the FPL) who do not qualify for Medicaid, MassHealth and who meet certain eligibility guidelines.
- It offers for purchase health insurance plans for individuals who:
- are not working,
- are employed by a small business (less than 50 employees) that uses the Connector to offer health insurance. These residents will purchase insurance with pre-tax income.
- are not qualified under their large employer plan,
- are self-employed, part-time workers, or work for multiple employers,
- It sets premium subsidy levels for Commonwealth Care.
- It defines "affordability" for purposes of the individual mandate.
"Commonwealth Care insurance (and Commonwealth Choice insurance for those not receiving subsidies) has been replaced by PPACA-consistent insurance for 2014. Among other differences, consistent with PPACA, the out of pocket spending limits and deductibles are much higher under similarly priced (after a PPACA tax credit) PPACA-consistent insurance than the now eliminated subsidized RomneyCare insurance
"Health Care Plans Provided through Commonwealth Health Insurance Connector Authority in 2014
"With the implementation of PPACA in 2014, those citizens acquiring insurance through currently available Massachusetts Health Connector plans will need to re-enroll or select a new plan given the new guidelines stipulated by PPACA. Approximately 100,000 Massachusetts residents who received free or highly subsidized CommonWealth Care insurance will be moved to Medicaid. The number of available plans blossomed under the Affordable Care Act to more than 100 that will offer service beginning 1 January 2014 from just under 100 in 2013. The open enrollment period of the insurance marketplace during which citizens may re-enroll or purchase lasts from 1 October 2013 to 31 March 2014, but those that do not re-enroll by December 15 will have no insurance coverage in January 2014 (unless they are among the 100,000 moved to Medicaid). Health plans are to be provided by Ambetter from CeltiCare, Blue Cross Blue Shield of Massachusetts (which did not particpate in the RomneyCare insurance program), Boston Medical Center HealthNet, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Minuteman Health, Neighborhood Health Plan (a new plan following the co-op model introduced with PPACA), Network Health, and Tufts Health Plan. The primary features of each plan are illustrated in this table based on the data provided at the Summary of Benefits & Coverage located within the Plan Information section of the Individuals and Families portal
"By comparison, Commonwealth Care insurance had either zero or $250 deductibles (depending on which of three types of Commonwealth Care insurance it was) and zero or very low co-pays as compared to the PPACA-consistent insurance (not illustrated in the table). "Not applicable" in the table above means that the subscriber cannot go out of network at all; it does not mean that the deductible does not apply. Both Commonwealth Care and PPACA-consistent insurance is networked and almost all versions of both insurances offered gym memberships.
"From 2006, the number of uninsured Massachusetts residents dropped from about 6% to about 2% in 2010 according to the Massachusetts Department of Healthcare Finance and Policy (DHCFP), depending on the methodology used. The United States Census Department shows a higher percentage of uninsured for the same years but a similar trend line.
"That trend line mirrors the approximately 400,000 Massachusetts residents added to the rolls of the "insured" in 2006/2007 via an expansion in Medicaid3 eligibility rules and the subsidization of the Commonwealth Care insurance program. A 2011 view of the data released by the state in 2013 shows the number of people receiving employer sponsored insurance (ESI) in Massachusetts has decreased by approximately 500,000 people (about 8% of the population) in Massachusetts since the enactment of the RomneyCare law in 2006.
"The state of Massachusetts stopped putting out regular information on various types of insurance enrollment altogether between 2011 and 2013; prior to 2011 it released such data quarterly. In 2013, the state released 2011 data. The latest U.S. Census data on health care insurance types in Massachusetts was released in September 2011 and also illustrates the long-term decrease in ESI and increase in public free and subsidized insurance.
1On the Wikipedia site, I left some old lefty-corrected words that no longer apply simply because the law changed substantially in 2012 and 2013. I have not included those out of date sections on this post. I have also not included some figures and tables – also misleading – that still appear on Wikipedia.
2The way Wikipedia works is that you update what someone else has written before, not changing it unless it is incorrect or out of date, and adding new information you think relevant – with citations4. I would not have included this information about ERs but the previous author was being consistent with the initial proposal by Governor Romney, which – inaccurately it turned out – seemed to think there was a lot of "free-riding" going on in Massachusetts via ERs
3Most people would not consider Medicaid insurance
4One of the other big problems with Wikipedia is that almost all the citations are inaccurate media articles rather than actual source material such as – in the case of RomneyCare – information released by the State of Massachusetts